Liver function and anemia pathogenesis in Iranian traditional medicine

Background: Nutritional deficiency, bleeding, and inflammation are three main causes of anemia. On the other hand, erythropoietin (EPO) production, iron availability, and a healthy bone marrow are essential for erythropoiesis. Recently, recombinant human erythropoietin (rhEPO) has been used to treat the patients already taking iron supplements. In Iranian traditional medicine literature, much has been written about anemia and its treatment. Objectives: This study aimed to review Iranian traditional medicine theories in the treatment of anemia. Materials and Methods: In the present study, authors have attempted to find the etiology and pathogenesis of anemia in Iranian traditional Medicine Literature and the views of ancient physicians in this field. Results: Our findings proved that Iranian traditional medicine defined anemia as blood humor production dysfunction, which is caused by several reasons mainly hepatic dysfunction. Thus, liver is supposed to be the most important organ in this regard. This will make considering hepatoprotective medicines in anemia even in patients with non-hepatic problems. Conclusions: The article presents the relation between anemia and liver dysfunction viewed by Iranian traditional medicine as an important finding in designing a treatment plan. Despite the new findings on the evaluation of liver function (i.e. laboratory tests), it seems that further studies for earlier evaluation of liver function in anemia are highly required. © 2015 Iranian Red Crescent Medical Journal

Pamphlet as a tool for continuing medical education: Performance assessment in a randomized controlled interventional study

Background: Pamphlet is a tool used for distance continuous professional development programs. In this study, we assessed the impact of an educational pamphlet on improving prescription writing errors in general physicians' performance. Methods: In this randomized controlled interventional study, we prepared a training pamphlet according to the most prevalent prescription writing problems. We randomized 200 participants among general physicians affiliated with Tehran Social Security Insurance Organization, and randomly divided them into intervention and control groups. Participants' prescriptions (N= 34888) were investigated over a month, and then the prepared pamphlet was sent out to the participants in the intervention group. After three months we examined their one-month prescriptions again (N= 30296) and investigated the changes in prescription errors. Results: There was no significant difference in the mean number of prescriptions in two groups before and after intervention (p= 0.076). Mean number of medicinal items reduced significantly in intervention group. Also mean number of prescriptions including injection drugs (p= 0.024), Corticosteroids (p= 0.036), Cephalosporin (p= 0.017) and non-steroidal anti-inflammatory drugs (p=0.005) reduced significantly. No significant differences were found for other errors. Conclusion: This study showed that use of an appropriate pamphlet has a considerable impact on improving general physicians' performance and could be applied for continuous professional development

Effect of Glucantime on blood parameters in patients with cutaneous Leishmaniasis

History and Objectives: Due to the possibility of side effects of Glucantime on blood parameters and in order to determine its effect on blood parameters, this study was performed on patients with cutaneous Leishmaniasis referred to central laboratory in Kashan in 1375. Materials and Methods: A clinical trial with comparison of peripheral blood smear before and after treatment in 70 patients with cutaneous Leishmaniasis, considering age, occupation and residential place of the patients complete blood count with RBC indices and platelet count were performed. Then Glucantime was administered 50 mg/kg day for 21 days by intramuscular injection and on the last day of treatment all the above examinations were repeated under the same conditions. Results were recorded and changes in blood parameters were compared by paired t-test. Results: This study revealed that treatment with Glucantime results in decrease in the number platelets (4.6), red blood cells (2.5), white blood cells (10.4), monocytes (12.7) and increase in ESR (50.4), lymphocytes (8.5), eosinophils (3.4), basophils (0.2), MCH (0.17), MCV (2.4), MCHC (0.23) while the average neutrophil and monocyte count, HCT, Hb and absolute WBC, RBC and platelet counts were decreased. Conclusion: Due to resulting changes following Glucantime administration, it is recommended to perform CBC and ESR in patients with cutaneous Leishmaniasis before treatment with Glucantime in order to use other therapeutic options in the presence of a hematologic disease

Investigate the Effect of Stagnant Zone Behavior in One-Dimensional Hydrodynamic Models and Solute Transport in Rivers

Introduction Showing the rivers as a one-dimensional problem has simplified or eliminated many processes affecting salinity transfer in the river. Storage processes are one of the factors affecting water quality in rivers. Generally, as a substantial factor, the limitation of observational data confines the use of two-dimensional and three-dimensional models, leading to the use of more widely employed one-dimensional models. Most existing computer models are developed based on the Advection-Dispersion Equation (ADE) and do not consider the storage zone. For this purpose, Modified Advection-Dispersion Equation (MADE) is proposed to consider the stagnant area by defining effective velocity and dispersion coefficient. In this study, a solution has been proposed to apply the effect of the Stagnant zone in water quality simulation in one-dimensional models. The river simulation is closer to the natural conditions. In this model, to prove the improvement of the proposed method, the average stagnant zone fraction expressed as the fraction of the average cross-sectional area of the river (η) and employed in a one-dimensional model through the definition of the effective velocity and the dispersion coefficient. This model is considered representative of the one-dimensional models developed only by the Advection /Dispersion relation, and the proposed method was investigated for the Arvand River. Observational data along the river were used to calibrate and validate the model. Materials and Methods Since the available and well-known one-dimensional computer programs are generally developed based on the 1D Advection-Dispersion model, they do not consider factors affecting salinity transport such as topography and river morphology heterogeneities known as storage areas. In such a way, these processes are not expressed by presenting the problem as a one-dimensional equation. In this research, in order to increase the accuracy of the simulation with well-known and available one-dimensional models a corrective solution is proposed. To compare the proposed modified method and the base ADE, at the first, the tidal and transboundary arvand river is modeled as a study area, which is a well-mixed river. The river's upstream and downstream boundary conditions were defined according to the available data in 2014. Manning's roughness parameters ranged from 0.017 to 0.033, and the dispersion coefficient was 285 m3/s according to previous studies. In order to apply the effect of stagnant areas in the modified equations, it is essential to determine the value of η for the river. This study uses three parameters of dispersion factor (a), dispersion exponent (b), and η by ant colony algorithm with the definition of 5 initial ants and 100 repetitions in Sehan station in the study area, Arvand river was optimized. The values of the estimated parameters are respectively η = 0.168, a = 273.4, b = 0.94. Therefore, in the modified model, corrections were made using the speed and effective dispersion coefficient as the modified Advection - Dispersion (MADE) method and considering variable dispersion coefficient depending on the flow's speed in the one-dimensional model. These changes were validated in the other two stations (Faw and Dweeb). Results and Discussion Based on this study results, increasing the parameter η caused the peak of the time series to rise and the river's travel time to decrease. The shortening of the water travel time in the river, although increases the dispersion coefficient due to the influence of the stagnant zone, the effect of this parameter on the time series of the simulated concentration is reduced. Like the observational data, the slope of falling and rising limbs is increased. By comparing the one-dimensional model in the two cases of using the effective dispersion coefficient and velocity and without it, the increase in accuracy in the simulation was determined at Sehan station - 123 km from the river formation site - after optimizing the coefficients with three statistical errors parameters. In addition, these changes at two other stations along the river with distances of 180 and 150 km from the river's source confirm this accuracy. For instance, the simulated and measured concentration in 12 months of the year by applying the optimized coefficients reaches the correlation coefficient (r) of 0.86 to 0.97 at a distance of 150 km from the upstream, and the root means square error (RMSE) improves 1.27 ppt. The remaining difference in the concentration estimation may be caused by the effect of other parameters or even the entry of agricultural runoff from the lands along the river. Conclusion Accurate estimation and simulation of concentration in river engineering have always been one of the environmental challenges. This research aimed to improve water quality simulation using one-dimensional model in well-mixed rivers. In order to increase the accuracy of the modeling and become closer to the actual conditions, correction factors such as considering the dead zones along the river have been suggested. Analysis showed that, on average, 16% of the surface of the Arvand River's cross-sections are stagnant areas, and the dispersion coefficient depends on the river's speed. These areas include bed dunes and meanderings of the river. The point that attracts attention is the tidal irrigation channels on the sides of the river. The results showed that in Sehan, Dweeb, and Faw stations, the root means square error decreases to 1.78, 1.27, and 0.84, respectively. Therefore, the modified 1D model estimated the concentration (in this study salinity) closer to the measurement data. In Dweeb and Sehan stations, the effect of dead zones such as river meandering is evident. Still, in Faw station, no significant improvement in the impact of stagnant zones was observed due to its proximity to the river mouth. The results of this research can be used for higher accuracy in one-dimensional water quality simulations and bringing the models closer to the natural conditions in rivers

Two case reports of Hodgkins lymphoma within a family

History and Objectives: Hodgkin's disease is a disorder of lymphoid tissues and is the most common malignancies among adults. Since infection is a causative factor, this study was carried out on two patients from a family in Shaheed Beheshti hospital in Kashan in 1999. The first patient was an 18-year man with chest pain, respiratory distress, weakness, weight loss and nightly perspiration and the second patient was his 12-yerar sister with weakness, weight loss and respiratory distress. The definite diagnosis of Hodgkin's disease was done according to biopsy. Conclusion and Recommendations: There was much evidence for infection and genetic history as causative factors. Therefore, appropriate measures should be taken to avoid contacts between individuals and to prevent the development of the disorder

Clinical and paraclinical criteria for Thyroid disorders in patients over 15 years

History and Objectives: Thyroid disorders are variant in different regions. Considering the significance of thyroid disorders, time-consuming and costly diagnostic methods and the suggestion of a scoring for early diagnosis, this study was carried out to compare the clinical and paraclinical criteria for thyroid disorders in referrals over 15 years in health centers of Kashan from 1997 to 2000. Materials and Methods: This diagnostic strategy of this study was conducted on patients at an age range of 15-60 years and suspicious to have thyroid disorders. In this respect, Flipp Fling scoring was used. A net score greater than 18 was considered hyperthyroidism, between 11 and 18 was considered as suspicious and less than 11 was considered as euthyroidism. In hypothyroid scoring, net score greater than 19 was considered as hypothyroidism. For all patients, measurement of T3, Free T4 and TSH was requested. Patients with TSH level lower than 0.3 microgram and T4 greater than 12 and T3 greater than 180 microgram were considered as hyperthyroid and patients with TSH level greater than 5 microgram and T4 less than 4 and T3 less than 8 microgram were considered as hypothyroid. Results: This study was carried out on 200 patients. Out of 150 suspicious cases, 31 (20.7) were male and 119 (79.3) were female. In addition, 100 out of them were supposed to have hyperthyroidism and 50 were supposed to have hypothyroidism. Most of the hypothyroid patients were female (80). 78 of hypothyroid patients were female. Therefore, thyroid disorder was more common in female ones. Sensitivity of scoring method for hyperthyroid state was 91 and for hypothyroid state was 76. Conclusion and Recommendations: Considering the costly paraclinical tests, Flipp Fling criteria are recommended to be used for diagnosis of thyroid disorders

Unacceptable results with an accepted soft tissue filler: Polyacrylamide hydrogel

Background: Polyacrylamide hydrogel, considered a safe and biocompatible soft tissue filler, is widely used in cosmetic procedures. Its use for facial contouring and breast augmentation in Iran has increased dramatically in recent years. Most patients and many doctors are unaware of possible and reported adverse effects related to its administration. Methods: This study enrolled 98 patients experiencing unsatisfactory results and complications of polyacrylamide hydrogel. Adverse effects related to gel administration were documented for all the patients. Lab values were requested together with related medical care and surgical treatments, and gel was extracted by incision, milking, and irrigation. Results: The most common findings at the time of presentation were inflammation (n = 51), asymmetry (n = 31), irregularity (n = 18), infection and abscess formation (n = 11), and gel migration (n = 8). In one patient, severe anaphylactoid reaction was observed 1 week after gel injection, which led to significant complications for the patient. Histologic findings showed granuloma formation (n = 17), fat necrosis (n = 9), and fibrosis (n = 17). Macroscopic gel-related complications resolved after extraction of the injected material, except for skin necrosis and hyperpigmentation, which remained unchanged. For eight patients, the gel could not be extracted by squeezing and irrigation entirely. Three patients experienced gel reaccumulation after seemingly complete removal of the gel. Conclusions: A wide range of complications seen among our patients showed that polyacrylamide hydrogel may not be as safe and biocompatible as it was thought previously. Both patients and physicians must be aware of the potential side effects of polyacrylamide hydrogel before gel administration. © 2009 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery

The impact of spleen disorders in the pathogenesis of anemia from the viewpoint of persian medicine

Spleen is one of the main components of reticuloendothelial system and plays an important role in controlling of red blood cell quality with elimination of old and damaged cells. Physicians of Traditional Persian Medicine believed that spleen has a high incorporation with the liver, and liver has a main role in blood production. So its pathologic changes influence the production of hematologic elements in both aspects of amount and quality. In this study, chapters related to spleen disease in several Traditional Persian Medicine textbooks and available databases were reviewed. Further the relationship between anemia and spleen diseases were derived and evaluated. After interviewing two experts about the findings and reaching data saturation, the results were compiled and explained. Spleen dysfunction and diseases can lead to anemia, because of intercommunity with liver. This happens with different mechanisms such as: enlargement, cold distemperment, asthenia and crisis. Although there are many studies so far about anemia, but role of the spleen in the development of anemia is still not well known. Considering the role of the spleen in developing anemia, the drugs used in Persian medicine for spleen-originated anemia may provide an appropriate solution to treat the disease. © 2018 The Authors

A 100-Gb/s PAM4 optical transmitter in a 3-D-integrated SiPh-CMOS platform using segmented MOSCAP modulators

This article presents a 100-Gb/s four-level pulse-amplitude modulation (PAM4) optical transmitter system implemented in a 3-D-integrated silicon photonics-CMOS platform. The photonics chip includes a push–pull segmented Mach–Zehnder modulator (MZM) structure using highly capacitive (415 fF–1.1 pF), yet optically efficient ( VπL=0.8V⋅ cm) metal–oxide–silicon capacitor (MOSCAP) phase modulators. Two pairs of U-shaped modulator segments with effective lengths of 170 and 450 μm are driven at 50 GBd by a dual-channel 28-nm CMOS driver, which is flip-chip bonded to the photonics chip. The driver cores utilize digitally controllable pre-distortion (PD) and inductive peaking to achieve sufficient electro-optical bandwidth (EOBW). The drivers deliver 1.2-Vppd swing to modulators using a 0.9-V supply and on-chip serializers that generate 50-Gb/s data streams. The electronics chip consumes 240 mW achieving 2.4-pJ/bit energy efficiency. The overall EOBW, without any PD, is increased by approximately 56% and 48% for the 170- and 450- μm segments, respectively, when compared to their EOBW measured by 65-GHz 50- Ω terminated probes. The optical input power to the photonics chip is +10 dBm, and an erbium-doped fiber amplifier amplifies output signals by 11 dB. The 50-Gb/s nonreturn to zero (NRZ) optical raw eye diagram exhibits 4.3-dB extinction ratio (ER) and 1.2 dBm of optical modulation amplitude (OMA). The 100-Gb/s PAM4 optical raw eye diagram shows 4.3-dB ER and 1.4-dBm OMA with a transmitter dispersion eye closure quaternary (TDECQ) of 1.53 dB after a five-tap feed-forward-equalization (FFE) filter. The PAM4 TDECQ changes by 53% when the temperature is increased from 30 °C to 90 °C at the optimum forward bias voltage of 1 V