Demographic and Clinical Characteristics of Patients Who Died of Methanol Toxicity During COVID 19 Period in Loghman-e Hakim Hospital in Tehran

Background: Outbreaks of methanol poisoning were observed during the COVID-19 pandemic. Acute methanol poisoning is a global crisis. Methanol can cause acute and fatal toxicity through metabolic acidosis. In the present study, we evaluated demographic, clinical, and paraclinical characteristics of patients who died in the recent outbreak of methanol poisoning in Tehran from March to April 2020. Methods: This cross-sectional study was accomplished at the Loghman-Hakim Hospital in Tehran on 80 patients who died of methanol toxicity. Demographic, clinical, and laboratory data were collected retrospectively from the patient’s files and analyzed with appropriate statistical tests.Results: Men were significantly more involved than women (%85 vs. %15). There were no significant differences between other characteristics of male and female patients, including the time between consumption to arrive hospital, dialysis sessions, pulse rate, respiratory rate, loss of consciousness, seizure, acute kidney injury, brain CT, and Intracerebral Hemorrhage ( ICH). Blood sugar, serum potassium, and liver function tests were higher than average in most of the patients.Conclusion: Our study showed that this outbreak of methanol poisoning was due to the use of alcoholic drinks that contain methanol. Men were primarily affected that could be because of the cultural and social status of our country. The greater seizure probability in females could be because of enhancing the NMDA receptor by estrogen. Abnormalities in Alanine aminotransferase (ALT), Aspartate Aminotransferase (AST), and Prothrombin Time (PT) were seen in most patients, indicating liver damage. Misbeliefs about the protective effects of alcohol consumption against COVID-19 may lead many to consume poorly made alcohols that contain methanol and outbreaks of methanol intoxication

Electrocardiographic manifestations in acute methanol poisoning cannot predict mortality

The aim of this retrospective observational case series was to determine electrocardiographic (ECG) manifestations in patients poisoned with methanol and see whether they could predict mortality. We also wanted to see whether there was an association between ECG changes and time elapsed between ingestion and treatment, age, sex, seizure, coma (Glasgow Coma Scale �8), arterial blood gas (ABG) parameters, and serum potassium levels on hospital admission. The study included 42 patients aged 31.14±12.5 years. Twenty-five survived and 17 died. Almost all patients had one or more abnormal ECG findings, including heart rate, rhythm, and conduction abnormalities. However, we found no significant difference between survivors and non-survivors. QTc interval did not correlate with time elapsed between ingestion and treatment, age, sex, seizure and coma, HCO3 -, or serum potassium level. Similarly, T waves showed no correlation with serum potassium. ECG abnormalities did not correlate with coma or seizure. Even though cardiotoxicity in methanol poisoning is high, none of the ECG abnormalities found in our study predicted mortality. This however does not rule out the need to routinely run ECG for cardiotoxicity in every single patient poisoned by methanol

Emulating opportunistic networks with KauNet Triggers

In opportunistic networks the availability of an end-to-end path is no longer required. Instead opportunistic networks may take advantage of temporary connectivity opportunities. Opportunistic networks present a demanding environment for network emulation as the traditional emulation setup, where application/transport endpoints only send and receive packets from the network following a black box approach, is no longer applicable. Opportunistic networking protocols and applications additionally need to react to the dynamics of the underlying network beyond what is conveyed through the exchange of packets. In order to support IP-level emulation evaluations of applications and protocols that react to lower layer events, we have proposed the use of emulation triggers. Emulation triggers can emulate arbitrary cross-layer feedback and can be synchronized with other emulation effects. After introducing the design and implementation of triggers in the KauNet emulator, we describe the integration of triggers with the DTN2 reference implementation and illustrate how the functionality can be used to emulate a classical DTN data-mule scenario

Performance Limits and Design Issues in Wireless Networks

The increasing utilization of networks, especially wireless networks, for different applications and in different aspects of modern life, has directed a great deal of attention towards the analysis and optimal design of networks. Distinguishing features of the wireless environment and the distributed nature of the network setup have raised many important challenges in finding the performance limits of different tasks such as communication, control, and computation over networks. There are also many design issues concerning the complexity and the robustness of wireless systems that should be addressed for a thorough understanding and an efficient operation of wireless networked systems. This thesis deals with a few of the challenges associated with the fundamental performance limits and optimal design of wireless networks. In the first part, we analyze performance limits of two applications for a special class of wireless networks called wireless erasure networks. These networks incorporate some of the essential features of the wireless environment. We look at the performance limits of two applications over these networks. The first application is data transmission with two different traffic patterns, namely multicast and broadcast. The capacity region and the optimal coding scheme for the multicast scenario are found, and outer and inner bounds on the capacity region for the broadcast scenario are provided. The second application considered in this thesis is estimation and control of a dynamical process at a remote location connected through a wireless erasure network to a sensor observing the process. In this case, we characterize the minimum steady-state error and its dependency on the parameters of the network. The final problem considered in the first part of the thesis concerns power consumption (as a performance measure) in wireless networks. We propose and analyze a simple scheme based on the idea of distributed beamforming that saves us in terms of power consumption for dense sensor and ad-hoc networks. We quantify this gain compared to the case when nodes have isolated communications without participating in the network. The second part of the thesis deals with two design issues in the downlink of cellular wireless networks. The first issue is related to quality of service provisioning in the downlink scenario. We investigate the problem of differentiated rate scheduling in which different users demand different sets of rates. We obtain explicit and practical scheduling schemes to achieve the rate constraints and at the same time maximize the throughput. These schemes are based on the idea of opportunistic beamforming, are simple, and require little amount of feedback to the transmitter. We further show that the throughput loss due to imposing the rate constraints is negligible for large systems. The next issue considered in this thesis is the robustness of the capacity region of multiple antenna Gaussian broadcast channels to the channel estimation error at the transmitter and the users. These channels are mathematical models for the downlink of cellular systems. We provide an inner bound on the capacity region of these channels and show that this inner bound is equivalent to the capacity region of a dual multiple access channel with a noise covariance that depends on the transmit powers. This duality is explored to show the effect of the estimation error on the sum-rate for a large number of users and in the large power regime. Finally, a training-based scheme for the block fading multiple antenna broadcast channels is proposed.</p

Managment of Organophosphate Poisoning Without Pralidoxim- Is It Possible .................IJMTFM (2011) 1(2):75-77

Introduction: Organophosphate compounds are used as insecticides, nerve gases, ophthalmic agents, and antihelmintics.The primary mechanism of action of organophosphate pesticides is inhibition of acetylcholinesterase (AChE). However  Pralidoxim has been introduced as organophosphate `s antidote but recent studies establish that pralidoxim has unclear benefit in treatment of organophosphate poisoning.We explain two cases of organophosphate poisoning that they treaeted well without pralidoxim. The first case was a 36-years old man with history of organophosphates poisoning. He was under mechanical ventilation. Atropine was initiated due to muscarinic signs such as salivation, bronchorrhea and auscultation of  alveolar rhales. On admission day, the pseudocholine esterase level was 235 unit per liter. Pralidoxime was not available, so we did not use it for management of this patient.The  patient was discharged when he was in free symptom completely on the 22th day. The second case was a 23 years old woman with the history of deliberate self poisoning with organophosphate compounds. Atropine was started and she was under mechanical. However, pralidoxim was not available. The pseudocholine esterase level was 1690 unit per liter on the first day which dropped to 952 unit per liter on the 2nd day. After 9 days the discharged from the hospital. Discussion: Pralidoxim has been introduced as organophosphate`s antidote, on the other hand, it has benefit in organophosphate poisoning theoretically, but patients can be treated without it. Key words: Organophosphate, Poisoning, Pralidoxi

مطالعه تطبیقی برنامه درسی اخلاق حرفه‌ای در برنامه آموزشی رشته کارشناسی تکنولوژی اتاق عمل در ایران و رشته‌های مشابه در دانشگاه‌های منتخب جهان

زمینه و هدف: تغییرات گسترده و سریع به دلیل ظهور نیازهای جدید در کنار نوآوری‌های فناوری و توسعه تکنیک‌های نوین جراحی و بیهوشی، تیم جراحی را با مسائل متعدد اخلاقی در اتاق عمل مواجه نموده است که بی‌شک ارائه یک مبحث تئوری با ساعاتی محدود، فاقد اثربخشی لازم خواهد بود. مطالعه حاضر با هدف مقایسه تطبیقی برنامه درسی اخلاق حرفه‌ای در رشته کارشناسی تکنولوژی اتاق عمل در ایران و رشته‌های مشابه در دانشگاه‌های منتخب جهان به منظور شناسایی راهکارهای اصلاحی برنامه موجود انجام شد. روش: پژوهش حاضر یک مطالعه تطبیقی است که بر اساس روش چهار مرحله‌ای تحلیل تطبیقی Bereday انجام شد. پس از جمع‌آوری اطلاعات، داده‌ها با استفاده از یک فهرست وارسی محقق‌ساخته بر اساس استراتژی ادغام‌ هاردن و مؤلفه‌های برنامه درسی تحلیل شده و با توجه ‌به شباهت‌ها و تفاوت‌ها در یک جدول جای‌گذاری شد، سپس بر اساس موضوع تحقیق در جهت شناسایی راهکارهای اصلاح برنامه درسی اخلاق حرفه‌ای اتاق عمل در کشور، موارد کلیدی و مهم شرح داده شد. ملاحظات اخلاقی: تحقیق حاضر از سوی کمیته اخلاق دانشگاه علوم پزشکی البرز به تأیید رسیده است. یافته‌ها: بر اساس نتایج مطالعه حاضر، درس اخلاق حرفه‌ای در بسیاری از دانشگاه‌ها به شکل ادغام و در طول دوره آموزشی، همراه با در نظرگرفتن اهداف آموزشی در حیطه‌های نگرشی و روانی ـ حرکتی علاوه بر حیطه شناختی، استفاده از روش‌های تدریس فعال همچون داستان‌نویسی، مبتنی بر سناریو، شبیه‌سازی و بحث گروهی و به کارگیری شیوه‌های ارزشیابی از جمله انجام پروژه، ثبت تجارب و بازاندیشی در کارپوشه و مشاهده مستقیم علاوه بر آزمون کتبی ارائه می‌شود. نتیجه‌گیری: در مقایسه با سایر دانشگاه‌های معتبر در دنیا، برنامه درسی اخلاق حرفه‌ای در اتاق عمل در کشور ایران از جنبه‌های مختلفی شامل استراتژی آموزشی، اهداف آموزشی، روش تدریس و شیوه ارزشیابی، اشکالات جدی دارد که مستلزم بازنگری و اصلاحات اساسی است.Background and Aim: Extensive and rapid changes owing to the arrival of new needs, along with technological innovations and the development of surgical and anesthesia techniques, has exposed surgical teams to various operating room ethical issues. Undoubtedly, offering a theoretical topic for a number of hours will not be sufficiently effective. The present study was conducted with the aim of comparing the professional ethics curriculums in the Operating Room Technology undergraduate program in Iran and in the similar disciplines in the selected universities around the world in order to identify the approaches to the revision of the existing program. Methods: The current research is a comparative study which was conducted based on Bereday’s four-step comparative analysis method. After data collection, the data were analyzed using a researcher-made verification checklist based on Harden's integration strategy and the curriculum components. Then they were placed in a table according to the similarities and the differences. Next the key and important items were explained based on the research topic in order to identify the approaches to the revision of the curriculum of the operating room professional ethics in the country. Ethical Considerations: The present research has been approved by the Ethics Committee of Alborz University of Medical Sciences. Results: According to the results of the present study, in many universities, the professional ethics course is offered in the form of integration during the training course. This course is offered considering the educational goals in the theoretical and psycho-motor dimensions, in addition to the cognitive dimension, and using active teaching methods such as story writing, scenario-based, simulation, and group discussion, as well as the assessment methods such as conducting projects, recording experience writing, case study, reflection writing in the portfolio, and direct observation in addition to the written test is offered. Conclusion: In comparison to other universities in the world, the curriculum of professional ethics in the operating room in Iran has serious defects in various aspects, including educational strategy, educational goals, teaching methods and assessment methods, which require revision and basic reforms. Please cite this article as: Sadati L, Motaharipour M, Edalattalab F, Farajidana H, Abjar R. A Comparative Study of Professional Ethics Curriculum in the Operating Room Technology Undergraduate Degree Program in Iran and in the Similar Disciplines in the Selected Universities Around the World. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2022; 16(47): e17.زمینه و هدف: تغییرات گسترده و سریع به دلیل ظهور نیازهای جدید در کنار نوآوری‌های فناوری و توسعه تکنیک‌های نوین جراحی و بیهوشی، تیم جراحی را با مسائل متعدد اخلاقی در اتاق عمل مواجه نموده است که بی‌شک ارائه یک مبحث تئوری با ساعاتی محدود، فاقد اثربخشی لازم خواهد بود. مطالعه حاضر با هدف مقایسه تطبیقی برنامه درسی اخلاق حرفه‌ای در رشته کارشناسی تکنولوژی اتاق عمل در ایران و رشته‌های مشابه در دانشگاه‌های منتخب جهان به منظور شناسایی راهکارهای اصلاحی برنامه موجود انجام شد. روش: پژوهش حاضر یک مطالعه تطبیقی است که بر اساس روش چهار مرحله‌ای تحلیل تطبیقی Bereday انجام شد. پس از جمع‌آوری اطلاعات، داده‌ها با استفاده از یک فهرست وارسی محقق‌ساخته بر اساس استراتژی ادغام‌ هاردن و مؤلفه‌های برنامه درسی تحلیل شده و با توجه ‌به شباهت‌ها و تفاوت‌ها در یک جدول جای‌گذاری شد، سپس بر اساس موضوع تحقیق در جهت شناسایی راهکارهای اصلاح برنامه درسی اخلاق حرفه‌ای اتاق عمل در کشور، موارد کلیدی و مهم شرح داده شد. ملاحظات اخلاقی: تحقیق حاضر از سوی کمیته اخلاق دانشگاه علوم پزشکی البرز به تأیید رسیده است. یافته‌ها: بر اساس نتایج مطالعه حاضر، درس اخلاق حرفه‌ای در بسیاری از دانشگاه‌ها به شکل ادغام و در طول دوره آموزشی، همراه با در نظرگرفتن اهداف آموزشی در حیطه‌های نگرشی و روانی ـ حرکتی علاوه بر حیطه شناختی، استفاده از روش‌های تدریس فعال همچون داستان‌نویسی، مبتنی بر سناریو، شبیه‌سازی و بحث گروهی و به کارگیری شیوه‌های ارزشیابی از جمله انجام پروژه، ثبت تجارب و بازاندیشی در کارپوشه و مشاهده مستقیم علاوه بر آزمون کتبی ارائه می‌شود. نتیجه‌گیری: در مقایسه با سایر دانشگاه‌های معتبر در دنیا، برنامه درسی اخلاق حرفه‌ای در اتاق عمل در کشور ایران از جنبه‌های مختلفی شامل استراتژی آموزشی، اهداف آموزشی، روش تدریس و شیوه ارزشیابی، اشکالات جدی دارد که مستلزم بازنگری و اصلاحات اساسی است

Elektrokardiografske manifestacije kod akutnog trovanja metanolom ne mogu predvidjeti smrtnost

The aim of this retrospective observational case series was to determine electrocardiographic (ECG) manifestations in patients poisoned with methanol and see whether they could predict mortality. We also wanted to see whether there was an association between ECG changes and time elapsed between ingestion and treatment, age, sex, seizure, coma (Glasgow Coma Scale ≤8), arterial blood gas (ABG) parameters, and serum potassium levels on hospital admission. The study included 42 patients aged 31.14±12.5 years. Twenty-five survived and 17 died. Almost all patients had one or more abnormal ECG findings, including heart rate, rhythm, and conduction abnormalities. However, we found no significant difference between survivors and non-survivors. QTc interval did not correlate with time elapsed between ingestion and treatment, age, sex, seizure and coma, HCO3-, or serum potassium level. Similarly, T waves showed no correlation with serum potassium. ECG abnormalities did not correlate with coma or seizure. Even though cardiotoxicity in methanol poisoning is high, none of the ECG abnormalities found in our study predicted mortality. This however does not rule out the need to routinely run ECG for cardiotoxicity in every single patient poisoned by methanol.Cilj je ovog retrospektivnoga opservacijskog istraživanja bio utvrditi elektrokardiografske (EKG) manifestacije u bolesnika otrovanih metanolom te vidjeti mogu li one poslužiti kao pretkazatelji smrtnosti. Također smo željeli utvrditi postoji li povezanost između promjena na EKG-u i vremena proteklog od unosa metanola do liječenja, zatim dobi, spola, epileptičkog napadaja, kome (≤8 prema ljestvici Glasgow), nalaza plinske analize arterijske krvni te razina kalija u serumu u trenutku hospitalizacije. Ispitivanje je obuhvatilo 42 bolesnika u dobi od 31.14±12.5 godine. Dvadeset i petero je preživjelo trovanje, a 17-ero umrlo. Gotovo su svi bolesnici imali jedan abnormalni EKG parametar ili više njih među kojima brzinu otkucaja srca, srčani ritam i provodljivost. Nismo međutim našli značajnih razlika između preživjelih i umrlih. QTc interval nije korelirao s vremenom proteklim od unosa metanola do liječenja, s dobi, spolom, epileptičkim napadajem, komom, HCO3- odnosno razinama kalija u serumu. Isto tako, T valovi nisu korelirali s kalijem u serumu. Abnormalni EKG nalazi nisu korelirali s komom i epileptičkim napadajima. Premda je kardiotoksičnost značajna kod trovanja metanolom, nijedan abnormalni EKG nalaz nije mogao predvidjeti smrtnost. To međutim ne isključuje potrebu za rutinskim EKG pregledima radi otkrivanja kardiotoksičnosti u svih bolesnika otrovanih metanolom

Development of Professional Ethics Curriculum in the Operating Room for the Current Era of Surgery: A Mixed Method Study

Introduction : Les progrès rapides des technologies complexes et l’émergence de nouvelles méthodologies chirurgicales nécessitent une prise de décision éthique nuancée dans des scénarios très stressants. Par conséquent, la compréhension de l’éthique professionnelle dans l’environnement chirurgical est cruciale pour tous les praticiens impliqués dans les soins aux patients. Cette étude a été lancée dans le but de concevoir un programme complet pour les facultés de médecine iraniennes, axé sur l’éthique professionnelle au sein de la salle d’opération. Méthodes : Cette recherche exploratoire à méthode mixte a été exécutée en phases qualitatives et quantitatives distinctes. La première étape a consisté à mener 12 entretiens semi-structurés avec des professeurs iraniens experts dans la formation à l'éthique professionnelle et le personnel des salles d'opération afin d'évaluer les besoins actuels et d'examiner les programmes existants. La phase quantitative suivante a consisté à évaluer les éléments de chaque axe du programme d’études par le biais de la méthode Delphi. Résultats : La phase qualitative a permis d’identifier 45 codes primaires, 14 sous-catégories et 5 catégories primaires. La phase quantitative a confirmé 3 domaines d’objectifs pédagogiques, 12 domaines de contenu pédagogique, 8 méthodologies d’enseignement et 10 méthodes d’évaluation par le biais du processus Delphi. Ces éléments confirmés ont finalement été incorporés dans divers cours théoriques et cliniques en tant que thèmes d’intégration longitudinale. Conclusion : Sur la base de nos résultats, nous recommandons l’élaboration d’objectifs pédagogiques ciblant les domaines cognitif, affectif et psychomoteur et l’intégration longitudinale d’un cours d’éthique professionnelle.Introduction: The rapid advancement of intricate technologies and the emergence of novel surgical methodologies necessitate nuanced ethical decision-making under high-stress scenarios. Consequently, cultivating an understanding of professional ethics within the surgical environment is crucial for all practitioners involved in patient care. This study was initiated with the aim of designing a comprehensive curriculum for Iranian medical schools, focusing on professional ethics within the operating room. Methods: This mixed-method exploratory research was executed in distinct qualitative and quantitative phases. The first stage involved conducting 12 structured interviews with Iranian faculty members who were experts in education of professional ethics and operating room staffs for assessing the current needs and reviewing extant curricula. The subsequent quantitative phase entailed evaluating the elements of each curriculum axis via the Delphi method. Results: The qualitative phase led to the identification of 45 primary codes, 14 subcategories, and 5 primary categories. The quantitative phase confirmed 3 instructional goal domains, 12 instructional content areas, 8 teaching methodologies, and 10 evaluation methods through the Delphi process. These confirmed components were eventually incorporated into various theoretical and clinical courses as longitudinal integration themes. Conclusion: Based on our findings, we recommend the development of educational objectives targeting cognitive, affective, and psychomotor domains and the longitudinal integration of a professional ethics course