Findings of Serial Computed Tomography Imaging in Patients with Coronavirus Disease-19

AIM: We investigated the serial changes of chest computed tomography (CT) in patients with coronavirus disease-2019 (COVID-19) presenting with viral-induced lung damage on follow-up CT. METHODS: We evaluated 66 patients with confirmed COVID-19, who had undergone at least two chest CTs from February 24 to April 21, 2020. Nine patients also had a third CT. All patients demonstrated viral-induced lung damage (organizing pneumonia-like pattern) on second CT. The involvement pattern of each lobe and the extent of infiltration (based on CT score) were assessed on serial CTs to determine changes throughout the disease course. Patients’ demographic and clinical data and final outcome were also recorded. RESULTS: Mean age (standard deviation [SD]) of patients was 56.04 (15.2) years old; 51.5% were male. About 93.9% of patients had survived. Mean (SD) interval between the first and second CT and second and third CT was 7.6 (5.9) and 16.8 (8.3) days, respectively. The extent of total lung involvement was significantly higher in the second CT compared with the first CT (p < 0.001) and also increased non-significantly in the third CT (p = 0.29). The right lower lobe persistently had the highest CT score through the disease course. CONCLUSION: Evaluation of serial CT imaging can reveal information regarding the stage of COVID-19, thus providing help for appropriate treatment planning

The Three-Objective Optimization Model of Flexible Workshop Scheduling Problem for Minimizing Work Completion Time, Work Delay Time, and Energy Consumption

In recent years, the optimal design of the workshop schedule has received much attention with the increased competition in the business environment. As a strategic issue, designing a workshop schedule affects other decisions in the production chain. The purpose of this thesis is to design a three-objective mathematical model, with the objectives of minimizing work completion time, work delay time and energy consumption, considering the importance of businesses attention to reduce energy consumption in recent years. The developed model has been solved using exact solution methods of Weighted Sum (WS) and Epsilon Constraint (Ɛ) in small dimensions using GAMS software. These problems were also solved in large-scale problems with NSGA-II and SFLA meta-heuristic algorithms using MATLAB software in single-objective and multi-objective mode due to the NP-Hard nature of this group of large and real dimensional problems. The standard BRdata set of problems were used to investigate the algorithms performance in solving these problems so that it is possible to compare the algorithms performance of this research with the results of the algorithms used by other researchers. The obtained results show the relatively appropriate performance of these algorithms in solving these problems and also the much better and more optimal performance of the NSGA-II algorithm compared to the performance of the SFLA algorithm

Porównanie wpływu leczenia metforminą i insuliną na kontrolę glikemii u krytycznie chorych pacjentów

Introduction: It is accepted that preventing hyperglycaemia during critical illness while assuring adequate caloric intake can reduce mortality and morbidity. The aim of this study was to compare the metabolic effects of metformin and insulin on hyperglycaemia in ICU patients. Methods: This double-blind randomised clinical trial was performed on 24 patients who were admitted to the intensive care unit (ICU) from 20 March to 20 September 2007. All patients with serious injuries or with major non-abdominal surgeries were included if they met the inclusion criteria, and were assigned randomly to one of the study groups. Patients in Group 1 received intensive insulin therapy, and patients in Group 2 were treated with metformin. Moreover, the Acute Physiology And Chronic Health Evaluation (APACHE) II scoring system was used to grade disease severity. Results: Both glycaemic management protocols led to significantly improved glucose levels without any report of hypoglycaemia. The mean initial glucose levels for the insulin group decreased significantly after the intravenous infusion of insulin (p < 0.001). Additionally, the blood glucose concentration was significantly lower after two weeks of metformin administration compared to baseline measurements (p < 0.001). Moreover, the blood glucose concentration decrease during these two weeks was significantly higher in the insulin group (p = 0.01). Besides, APACHE II score was lower than baseline at the end of the study for both therapeutic groups (score of 10 vs. 15 [insulin] and 16 [metformin]). Finally, new renal dysfunction (maximum serum creatinine level at least double the initial value) was observed in three of the patients (two patients from the metformin group and one from the insulin group) in the last days of the protocol, although none of the patients showed lactic acidosis after ICU admission. Conclusions: Both metformin and intensive insulin therapy significantly decreased hyperglycaemia in ICU patients. Insulin caused a greater reduction in blood glucose concentration but required more attention and trained personnel.Wstęp: Dowody naukowe wskazują, że zapobieganie hiperglikemii u osób w stanie krytycznym przy zapewnieniu odpowiedniego poboru kalorii może zmniejszyć śmiertelność i chorobowość. Celem niniejszego badania było porównanie wpływu metforminy i insuliny na występowanie hiperglikemii u pacjentów leczonych na oddziale intensywnej opieki medycznej (OIOM). Materiał i metody: Badanie z randomizacją przeprowadzone metodą podwójnie ślepej próby obejmowało 24 chorych przyjętych na OIOM w okresie od 20 marca do 20 października 2007 roku. Wszystkich pacjentów z ciężkimi obrażeniami lub po poważnych zabiegach chirurgicznych niedotyczących jamy brzusznej, którzy spełniali kryteria włączenia, przydzielono losowo do jednej z grup terapeutycznych. U chorych przydzielonych do grupy 1. stosowano intensywną insulinoterapię, natomiast chorym z grupy 2. podawano metforminę. Do oceny ciężkości stanu chorych wykorzystano skalę APACHE (Acute Physiologic Assessment and Chronic Health Evaluation) II. Wyniki: Oba protokoły leczenia hipoglikemizującego spowodowały istotną poprawę wyrównania glikemii, przy czym nie odnotowano żadnego przypadku hipoglikemii. W grupie stosującej insulinoterapię średnie stężenie glukozy obniżyło się istotnie w stosunku do wartości wyjściowych po dożylnym wlewie insuliny (p < 0, 001). U osób leczonych metforminą po 2 tygodniach przyjmowania leku stężenie glukozy we krwi było istotnie niższe od poziomu wyjściowego (p < 0,001). Redukcja stężenia glukozy w ciągu tych 2 tygodni była istotnie większa w grupie przyjmującej insulinę (p = 0,01). W obu grupach terapeutycznych punktacja w skali APACHE II w momencie zakończenia badania była niższa od wartości wyjściowych (10 punktów v. 15 [insulina] i 16 [metformina]). U 3 chorych (2 osoby przydzielone do leczenia metforminą i 1 osoba przydzielona do insulinoterapii) zaobserwowano rozwój niewydolności nerek de novo (maksymalne stężenie kreatyniny w surowicy co najmniej 2-krotnie większe od wartości wyjściowych) w ostatnich dniach stosowania protokołu leczenia hipoglikemizującego, chociaż u żadnego z pacjentów nie stwierdzono kwasicy mleczanowej po przyjęciu na OIOM. Wnioski: Zarówno leczenie metforminą, jak i intensywna insulinoterapia istotne zmniejszają hiperglikemię u pacjentów na OIOM. Insulina powoduje większą redukcję stężenia glukozy, jednak jej stosowanie wymaga większej uwagi, a personel medyczny musi być odpowiednio przeszkolony

Clinical Characteristics of Fatal Cases of COVID-19 in Tabriz, Iran: An Analysis of 111 Patients

Introduction: The rapid worldwide spread, in addition to the morbidity and mortality associated with the novel coronavirus disease 2019 (COVID-19), have raised concern throughout the world. Identifying the characteristics of patients who died of COVID-19 is essential to implement preventive measures.&nbsp;Objective: We aimed at investigating these characteristics among the Iranian population in Tabriz.&nbsp;Methods: In this case series, we analyzed clinical characteristics, laboratory parameters, and imaging findings of 111 patients with a reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 diagnosis who died during hospitalization. The studied patients had been admitted to the hospital between February 2020 and May 2020.&nbsp;Results: The median age of patients was 73 years (IQR, 62-82 years) and approximately 70% of them were male. The median oxygen saturation on admission was 88% (IQR, 80-92%) and dyspnea, cough, and fever were the most common presenting symptoms. Among comorbidities, diabetes, hypertension, and cardiovascular diseases were more frequently observed among patients who had a fatal outcome. While ground-glass opacity was the most commonly reported finding on chest computed tomography, 5% of the patients had no abnormal finding on imaging. Chloroquine was the most frequently used medication for treatment.&nbsp;Conclusion: Our results showed that the majority of COVID-19 deaths occurred in male elderly with decreased levels of oxygen saturation and elevated levels of lactate dehydrogenase and erythrocyte sedimentation rate on admission

The effect of swimming and silymarin on placental growth factor in pregnant rats exposed to cadmium

Background: Exercise and dietary supplements can partially mitigate the negative effects of cadmium. The present study aimed to investigate the effect of swimming and silymarin on placental growth factor (PLGF) in pregnant mice exposed to cadmium. Methods: Seventy-two 8-week-old pregnant Wistar rats (weighing 20 ± 200 g) were divided into 9 groups, with 8 rats in each group. Cadmium chloride at a dose of 400 mg/kg body weight was fed to rats by drinking a water solution. Silymarin (100 mg/kg body weight) was injected subcutaneously 3 times a week. The exercise program during pregnancy consisted of 60 minutes of swimming per day, conducted for 5 days a week. The microscopic sections of samples were taken 2 days after birth using the usual method of tissue sectioning. A 1-way analysis of variance (ANOVA) and Tukey post hoc test at the error level of 0.05 were used to analyze the data. Results: The PLGF index in the cadmium group showed a significant decrease (P < 0.001) compared to the cadmium + silymarin and cadmium + silymarin and swimming groups. However, swimming training alone had no effect on PLGF index (P = 0.162). Conclusion: Cadmium significantly reduced PLGF levels in neonatal lung tissue, and regular swimming endurance exercises and silymarin supplementation inhibited the effects of cadmium chloride

The spiritual experiences of students of Iran University of Medical Sciences in 2020

Background: Psychologists consider the acceptance of spirituality as a cultural reality and by acknowledging the positive effects of spirituality on mental health, the World Health Organization also considers the spiritual dimension as the physical, social and emotional dimensions of human existence. Spirituality is a genuine and inner experience that It lies in the nature of every human being. The purpose of this study was to investigate the spiritual experiences of students of Iran University of Medical Sciences in 2020. Methods: The present study was descriptive-analytical. The sample size of 500 students of Iran University of Medical Sciences in 2020 was estimated. For sampling, a list of students was prepared from the faculty education and the sample was selected by regular random sampling method through random number generation software. The data collection tool was a questionnaire with demographic questions and spiritual experiences. The collected data were analyzed after completion with SPSS 20 software. A significance level of 0.05 was considered. Results: The mean score of the meaning-finding component in life was obtained at 57.98. There was a significant relationship between spiritual experiences and gender, age and educational level of students, while no significant relationship was found between spiritual experiences and marital status and residence. Conclusion: In order to ensure the spiritual health of students, it is necessary to plan properly to create a meaningful atmosphere in universities for different age and gender groups

Photography Methodology in Organizational and Management Studies: Philosophical Foundations, Characteristics, Implementing Factors and Criticisms

The Photo as a means of interaction between the viewer and the image has a different meaning. This means using icons and symbols, mental feelings which can then be used in interpreting the findings. Therefor, the authors of this paper introduce the use of photo as an organizational method. To this end, the general framework for the use of various techniques of photography are offered in organizational and management studies and more in the direction of greater importance to the problem describe the theoretical foundations of organizational Photography fully described and in the end, the critisicms of using this method is described to understand the concept of the photographic in organization and management studies is to provide researchers

Effects of Problem, Intervention, Evaluation (PIE) Training on the Quality of Nursing Documentation Among Students of Hamadan University of Medical Sciences, Hamadan, Iran

Background: Documentation of nursing care is one of the most important professional responsibilities of nurses and one of the major components of medical care and patient record documentation. Objectives: The present study was performed to determine the effect of problem, intervention, evaluation (PIE) training on the quality of nursing students' documentation. Methods: In this semi-experimental single-group study with a pretest-posttest design, a total of 28 nursing students were selected by simple random sampling. The data collection tools included a demographic questionnaire, PIE documentation form, and documentation quality checklist. First, the students were asked to write two reports using the traditional or narrative method. Then, a training workshop was organized about PIE documentation, and the students were asked to use this method and write two more reports about the same patient on two consecutive days; overall, each student presented four reports. A total of 112 reports were analyzed using descriptive statistics and paired t test in SPSS. Results: Based on the results of paired t test, there was a significant difference in the mean score of documentation quality between the pretest and posttest (P < 0.001). Also, there was a significant difference in the mean score of documentation quality between the pretest and posttest in terms of both report structure and content (P < 0.001). Conclusions: Use of PIE reporting system improves the quality of nursing documentation. Therefore, it can be a suitable alternative for the current narrative or traditional method. Keywords Nursing Documentation Problem-Based Reporting Nursing Student

Investigating possible effects of aryl hydrocarbon receptor G1661A polymorphism on asthma severity in adults

311-319Aryl hydrocarbon Receptor (AhR) is a ligand-activated transcription factor with an important role in lung health. The association of AhR polymorphisms with asthma severity has not been yet investigated. We analyzed the association of G1661A, the most prevalent polymorphism of AhR, with the asthma stages in a population-based study including 555 asthmatics (Intermittent: 93, Mild: 240, Moderate: 158, and Severe: 64). The SNP was genotyped using allele-specific PCR. Obtained data were analyzed using the Generalized-Ordered Logit Estimates. Genotypes GA (OR: 0.53, CI: 0.32-0.90, P=0.019) and AA (OR: 0.22, CI: 0.06-0.76, P=0.017) were associated with decreased risk of Severe, Moderate, Mild vs. Intermittent stage; and Severe, Moderate, vs. Mild, Intermittent stages respectively. However, Genotype GA (OR: 1.90, CI: 1.05-3.44, P=0.033), dominant model GA+AA (OR: 2.04, CI: 1.17-3.57, P=0.012), and allele A (OR: 1.68, CI: 1.06-2.66, P=0.027) were associated with increased risk of Severe stage vs. Moderate, Mild, Intermittent stages. Also, male sex and higher age were associated with an increased odds ratio for severe asthma. Furthermore, significant associations with asthma stages were found for the interactions of the SNP and sex, smoking, and alcohol consumption. In conclusion, we revealed that the mutant allele of AhR-G1661A may interact with independent variables and act as a protective factor against lower stages of asthma but it may increase the risk of severe asthma