Atypical Presentation of Massive Pulmonary Embolism, a Case Report

The lack of pathognomonic signs and symptoms makes the diagnosis of pulmonary embolism (PE) difficult. Here, we report a case of a 42-year-old man presented to the emergency department with worsening epigastric pain, hypotension, frank bradycardia, and final diagnosis of PE. Although previous studies have indicated that abdominal pain was observed in 6.7% of patients with PE, the exact reason for abdominal pain in PE still remains unknown. Tension on the sensory nerve endings, hepatic congestion, and distention of Gilson’s capsule are some of the possible mechanisms of abdominal pain in PE. We conclude that emergency physicians should pay more attention to PE, which is an important differential diagnosis of shock state. In this context, rapid ultrasound in shock (RUSH) should be considered as a vital sign that needs to be evaluated when recording the history of patients presented to the emergency department with signs and symptoms of shock

Nested Parallelism with Algorithmic Skeletons

New trend in design of computer architectures, from memory hierarchy design to grouping computing units in different hierarchical levels in CPUs, pushes developers toward algorithms that can exploit these hierarchical designs. This trend makes support of nested-parallelism an important feature for parallel programming models. It enables implementation of parallel programs that can then be mapped onto the system hierarchy. However, supporting nested-parallelism is not a trivial task due to complexity in spawning nested sections, destructing them and more importantly communication between these nested parallel sections. Structured parallel programming models are proven to be a good choice since while they hide the parallel programming complexities from the programmers, they allow programmers to customize the algorithm execution without going through radical changes to the other parts of the program. In this thesis, nested algorithm composition in the STAPL Skeleton Library (SSL) is presented, which uses a nested dataflow model as its internal representation. We show how a high level program specification using SSL allows for asynchronous computation and improved locality. We study both the specification and performance of the STAPL implementation of Kripke, a mini-app developed by Lawrence Livermore National Laboratory. Kripke has multiple levels of parallelism and a number of data layouts, making it an excellent test bed to exercise the effectiveness of a nested parallel programming approach. Performance results are provided for six different nesting orders of the benchmark under different degrees of nested-parallelism, demonstrating the flexibility and performance of nested algorithmic skeleton composition in STAPL

Performance of Local Anesthesia with Lidocaine among Opium Addicts and Non-Addicts; a Case Control Study

Introduction: Compared to ordinary people, addicts usually have a lower pain threshold. The current work attempts to compare the performance of local analgesia with lidocaine among opium addicts and non-addicts.Methods: In this case-control study, opium addicts and healthy patients with skin laceration referring to emergency departments of two educational hospitals were compared regarding the response to local anesthesia with lidocaine, as well as side effects.Results: 197 cases with the mean age of 43.44 ± 20.12 years were studied (72.1% male). 98 (49.8%) cases were addicts and 99 (50.2%) were healthy people. Two groups were similar regarding age (p = 0.281), sex (p = 0.666), and wound size (p = 0.272). The amount of pain reduction 5 (df =1.5, F=0.38, p = 0.88) and 10 (df =1.5, F=0.58, p = 0.72) minutes after lidocaine injection was not different between the groups. Subgroup analysis based on sex and age of patient did not show any differences between the groups (p > 0.1 for all analysis). The mean duration of analgesia was 16.4 ± 5.37 minutes in addicts and 16.95±1.79 in control group (p = 0.334).Conclusion: Lidocaine, as a commonly used local anesthetic agents, does not show different effects in addicts and non-addicts in repairing skin laceration

Spontaneous Spinal Epidural Hematoma; a Case Report

Spontaneous spinal epidural hematoma (SSHE) is a rare entity can have several reasons. Its prevalence in population is 0.1 per 100,000 with the male to female ratio of 1/4:1. For the first time Jackson in 1869 reported a case of SSHE and after that it was declared as several hundred cases in literatures. Here, a case of SSHE was reported in a 52 year-old male referred to emergency department following severe low back pain

The effects of mobile phone waves (940MHz) on embryonic development of hematopoiesis system in Balb/C mouse.

زمینه و هدف: استفاده روز افزون از دستگاه های مولد مایکروویو نظیر تلفن های همراه در زندگی روزمره سبب نگرانی های بسیاری در مورد اثرات امواج آنها بر سلامت انسان شده است. در تحقیق حاضر اثرات امواج شبیه سازی شده تلفن های همراه با فرکانس 940 مگا هرتز بر سیستم خون ساز جنین موش بررسی شده است. روش‌ بررسی: در یک مطالعه تجربی موش ماده حامله نژاد Balb/C به گروه های کنترل، شاهد آزمایشگاهی و تجربی 1 و 2 (حداقل 5 سر موش در هر گروه) تقسیم شدند. گروه تجربی از روز هشتم رشد و نمو جنین به مدت 4 یا 10 روز (هر روز به مدت 4 ساعت) با امواج شبیه سازی شده تلفن های همراه (940 مگا هرتز) مواجه شدند. در پایان دوره تیماری نمونه‌های مربوطه تشریح و ابتدا وزن و طول فرق سری ـ نشیمنگاهی جنین ها اندازه گیری و سپس برای انجام مطالعات بافت شناسی با میکروسکوپ نوری آماده سازی و به روش هماتوکسیلین ائوزین هاریس رنگ آمیزی شد. داده های کمی حاصل به کمک آزمون آماری t و من ویتنی تجزیه و تحلیل شد. یافته ها: بررسی ریخت شناسی جنین ‌های 18 روزه هیچگونه ناهنجاری نشان نداد. همچنین بین گروه ها تغییر معنی دار در طول فرق سری نشیمنگاهی مشاهده نشد، لیکن وزن جنین های تجربی (gr 017/0±263/1) نسبت به شاهد (gr 006/0±268/1) افزایش معنی دار نشان داد (05/0

Correlation between major depressive disorder and circulating natural killer cells

 Background: Major depressive disorder is a mental disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and loss of interest or pleasure in normally enjoyable activities. Depression is associated with multiple immunological disorders. Aim of the present study was to determine correlation between percentage of circulating NK cells and major depressive disorder.Materials and Methods: Patients older than 18 years with the desire to participate were enrolled in this study. For depression evaluation, we used the Hamilton Depression Rating Scale and for determination of percentage of NK cells in peripheral blood, flow cytometry method was used. Results: Our results showed that in patients with major depressive disorder, numbers of circulating NK cells have significantly reduced. Conclusion: According to our findings, depression is associated with “immune suppression”. NK cells are important in early phase of immunological surveillance versus viral infections and tumors. Indeed, depressive patients are susceptible to cancers and infections

Relationship between Dyspnea Descriptors and Underlying Causes of the Symptom; a Cross-sectional Study

Introduction: History taking and physical examination help clinicians identify the patient’s problem and effectively treat it. This study aimed to evaluate the descriptors of dyspnea in patients presenting to emergency department (ED) with asthma, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD). Method: This cross-sectional study was conducted on all patients presenting to ED with chief complaint of dyspnea, during 2 years. The patients were asked to describe their dyspnea by choosing three items from the valid and reliable questionnaire or articulating their sensation. The relationship between dyspnea descriptors and underlying cause of symptom was evaluated using SPSS version 16. Results: 312 patients with the mean age of 60.96±17.01 years were evaluated (53.2% male). Most of the patients were > 65 years old (48.7%) and had basic level of education (76.9%).  "My breath doesn’t go out all the way" with 83.1%, “My chest feels tight " with 45.8%, and "I feel that my airway is obstructed" with 40.7%, were the most frequent dyspnea descriptors in asthma patients. "My breathing requires work" with 46.3%, "I feel that I am suffocating" with 31.5%, and "My breath doesn’t go out all the way" with 29.6%, were the most frequent dyspnea descriptors in COPD patients. "My breathing is heavy" with 74.4%, "A hunger for more air” with 24.4%, and "I cannot get enough air" with 23.2%, were the most frequent dyspnea descriptors in CHF patients. Except for “My breath does not go in all the way”, there was significant correlation between studied dyspnea descriptors and underlying disease (p = 0.001 for all analyses). Conclusion: It seems that dyspnea descriptors along with other findings from history and physical examination could be helpful in differentiating the causes of the symptom in patients presenting to ED suffering from dyspnea. 

Characterization of bovine calpastatin gene in Nelore cattle using polymerase chain reaction-restricted fragment length polymorphisms

Problem statement: In beef cattle production, of meat quality and carcass traits are important. Traditionally beef cattle breeding programs unfortunately are time consuming and also recording of carcass and growth traits need heavy cost, Approach: Marker Assisted Selection (MAS) should be utilized in beef herds, along with economically important phenotypic traits, for genetic progress to made with respect to improving the uniformity and consistency of beef. Blood samples were collected from 41 nelor cattle in Malaysia. Forward and reversed primers amplified a 1552 bp fragment from calpastatin gene. XmnI enzyme was used for restriction analysis of PCR products. Result: Overall, the frequency of alleles A and B in the studied breeds were estimated as 0.42 and 0.58, respectively. In this study we calculated genotype frequency AA, AB and BB 12.2, 58.53 and 29.27% respectively and also observed heterozygosity, expected heterozygosity and average value of heterozygosity were 0.58, 0.49 and 0.48 respectively. Highest frequency of allele was B (0.58) and lowest was A (0.42) This Nelor cattle population was in the Hardy-Weinberg equilibrium. Conclusion: Perhaps, this molecular genetic information helps breeders for designing the proper genetic selection program in the development direction of this breed

Development of an Easy-to-Use Tool for the Assessment of Emergency Department Physical Design

Physical design of the emergency department (ED) has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed.  Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. Overall 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a “Yes or No” question for ease of analysis, meaning that the criterion is either met or not.

Effect of oral vitamin C on atrial fibrillation development after isolated coronary artery bypass grafting surgery: A prospective randomized clinical trial

Background: Some evidences have shown the role of antioxidant vitamins in preventing atrial fibrillation (AF) after coronary artery bypass grafting (CABG) surgery. We sought to determine the effect of oral vitamin C on the incidence of postoperative AF in patients undergoing elective isolated on-pump CABG surgery. Methods: One-hundred patients who underwent isolated CABG surgery were prospectively assigned into two groups: Group 1 — 50 patients received 2 g of oral vitamin C before and 500 mg twice daily lasting for 5 days after surgery; Group 2 — 50 patients as the control group did not receive any. All patients were continuously monitored after surgery in the intensive careunit (ICU), and then Holter monitoring was implemented for 72 h. Results: The mean of patients’ age was 61.31 ± 6.42 years. Postoperative AF occurred in 16 and 4 patients in control and treatment groups, respectively (32% vs. 8%, p = 0.003). The ICU stay was 1.79 ± 0.313 and 2.10 ± 0.61 days for vitamin C and control groups, respectively (p = 0.002). The hospital stay was significantly lower in vitamin C group compared with that of the control group (5.32 ± 0.59 vs. 5.74 ± 1.30 days, respectively, p = 0.041). Baseline erythrocyte sedimentation rate (OR 1.030, 95% CI 1.003–1.058, p = 0.030) and taking vitamin C (OR 8.068, 95% CI 1.783–36.517, p = 0.007) were the independent predictors of postoperative AF. Conclusions: Oral vitamin C can be safely used to decrease the incidence of postoperative AF in patients undergoing elective isolated on-pump CABG surgery.