Comparing the effect of using normal saline, N-acetyl cysteine and not using them in endotracheal tube suction on physiologic parameters and the amount of secretions in intubated patients under mechanical ventilation

Aims: Today a large number of patients hospitalized in Intensive Care Unit need mechanical ventilation via an artificial air way. Since these patients have endotracheal tube, endotracheal suctioning is necessary for increasing oxygenation, cleaning the airway and keeping it open. But this method consists of various side effects such as increased blood pressure and heart rate and respiratory rate, cyanosis, dizziness and increased intracranial pressure and hypoxia. This study aimed at comparing the effect of using normal saline serum, N-acetyl cysteine and not using them in endotracheal suctioning on physiologic parameters and the amount of secretions in intubated patients under mechanical ventilation. Material & Methods: It was a controlled clinical trial study with random allocation that was performed on 54 intubated patients hospitalized in ICU of health educational centers of Babol Medical Sciences University in 2014. Endotracheal tube suctioning was performed for each patient once without saline, the second time with 3 ml of normal saline and the third time with 2 ml of N-acetyl cysteine. Blood pressure, Heart rate, Respiratory rate, Arterial oxygen saturation were measured and recorded before each stage of suctioning and two and five minutes after that. Amount of secretions was measured after each method of suctioning. Data were analyzed by SPSS16 statistical software, variance analysis with repeated measures, ANOVA and paired t statistical tests. Results: Blood pressure, Heart rate and Respiratory rate were increased after suction in all the three groups, but these changes were higher in the group that received normal saline. Mean decrease of Arterial oxygen saturation was more in the method of receiving normal saline (p<0.05). The amount of secretion was more in the method of receiving N-acetyl cysteine (p=0.004). Conclusions: Endotracheal tube suctioning by using normal saline had more adverse effects on post- suction physiological parameters in compare with the other two methods. Therefore, it is recommended to not use normal saline in endotracheal tube suctioning to the possible extent, and if removing secretions is required, endotracheal N_acetyl cysteine should be used according to the patient's condition

Facies analysis and paleoenvironmental reconstruction of Upper Cretaceous sequences in the eastern Para-Tethys Basin, NW Iran

Upper Cretaceous mixed carbonate-siliciclastic sequences are among the most important targets for hydrocarbon exploration in the Moghan area, located in the eastern Para-Tethys Basin. Despite of their significance, little is known about their facies characteristics and depositional environments. Detailed facies analysis and paleoenvironmental reconstruction of these sequences have been carried out in eight surface sections. Accordingly, four siliciclastic facies, eight carbonate facies and one volcanic facies have been recognized. Detailed facies descriptions and interpretations, together with the results of facies frequency analysis, standard facies models and Upper Cretaceous depositional models of Para-Tethys Basin, have been integrated and a non-rimmed carbonate platform is presented. This platform was affected by siliciclastic influx, in the form of coastal fan delta and submarine fans in the shallow- to deep-marine parts, respectively. This model is interpreted to be shallower in the central and northeastern parts of the Moghan area. Toward the southeast and southwest, this shallow platform turns into deep marine settings along steep slopes without remarkable marginal barriers

Effects of different heat processing methods of rapeseed on ruminal and post-ruminal nutrient disappearance

Due to improving the nutritive value of oilseeds and changing their digestion site in ruminants, processing, including heat treatment, seems necessary. The present research was conducted to evaluate the effect of applying heat processing such as roasting, microwaving and autoclaving on nutritive values; the amount and rate of degradability in rumen, and the disappearance of rapeseed nutrients in rumen, post-rumen and total tract. This evaluation was performed using mobile nylon bags techniques; three-step method of digestion and protein CNCPS fraction. A completely randomized design was used to investigate the effect of applying heat processing, and SAS software was used to analyze the data. The field Emission Scanning Electron Microscope was used to monitored the effect of heat treatment on surface of rapeseed. The application of heat processing in this research (roasting, microwaving and autoclaving) had no significant effect on the chemical composition of rapeseed. The results obtained from mobile nylon bags method and three-step digestion method showed that raw rapeseed has the highest disappearance of DM and CP in rumen and therefore has a significant difference with processed seeds (P&lt;0.05). Also, the disappearance of DM and CP of processed rapeseed in intestines was significantly higher than raw seed (P&lt;0.05), and this was higher than other processing for autoclaved rapeseed. According to the results obtained from CNCPS protein fractionation, applying heat processing altering protein fractionation (P&lt;0.05). Applying microwave processing has created cracks in the surface of the rapeseed wall, and this condition was not observed in the wall surface of other heated seeds. In general, it can be said that in addition to increasing the digestibility of rapeseed in the entire gastrointestinal tract, applying heat processing reduces its degradability in the rumen and has increased the disappearance of nutrients in the intestine, that it can be stated the digestion site is altered from rumen to intestine, which can prevent the loss of protein sources in ruminant feed

Supercontinuum Generation using Mode-Locked picoseconds Pulse Laser

Supercontinuum (SC) generations in two nonlinear fibers are demonstrated using a passively mode-locked Erbium-doped fiber laser (EDFL). The EDFL is constructed using a semiconductor saturable absorber to generate 1.3 ps pulses with average power of 4.9 mW and repetition rate of 9.9 MHz at 1564 nm. The picosecond pulses are amplified by an Erbium-doped fiber amplifier to achieve an average output power of 13 dBm before it is launched into a 50m long photonic crystal fiber (PCF) and 100 m long highly nonlinear fiber (HNLF) for SC generation. Continuums starting from 1210 nm and 1370 nm for PCF and HNLF, respectively up to wavelength region of more than 1750 nm are achieved with average power of 10 dBm, which corresponds to 50% power conversion efficiency from pump to continuum

Fairness of Financial Contribution in Iranian Health System: Trend Analysis of National Household Income and Expenditure, 2003-2010

BACKGROUND: Social systems are dealing with the challenge of achieving fairness in the distribution of financial burden and protecting the risk of financial loss. The purpose of this paper is to present a trend analysis for the indicators related to fairness in healthcare's financial burden in rural and urban population of Iran during the eight years period of 2003 to 2010. METHODS: We used the information gathered by statistical center of Iran through sampling processes for the household income and expenditures. The indicators of fairness in financial contribution of healthcare were calculated based on the WHO recommended methodology. The indices trend analysis of eight-year period for the rural, urban areas and the country level were computed. RESULTS: This study shows that in Iran the fairness of financial contribution index during the eight-year period has been decreased from 0.841 in 2003 to above 0.827 in 2010 and The percentage of people with catastrophic health expenditures has been increased from 2.3 to above 3.1. The ratio of total treatment costs to the household overall capacity to pay has been increased from 0.055 to 0.068 and from 0.072 to 0.0818 in urban and rural areas respectively. CONCLUSION: There is a decline in fairness of financial contribution index during the study period. While, a trend stability of the proportion of households who suffered catastrophic health expenditures was found

Methanol mass poisoning in Iran: Role of case finding in outbreak management

Background There are no guidelines addressing the public health aspects of methanol poisoning during larger outbreaks. The current study was done to discuss the role of active case finding and a national guideline that organizes all available resources according to a triage strategy in the successful management of a methanol mass poisoning in Rafsanjan, Iran, in May 2013. Methods A retrospective cross-sectional study was performed reviewing the outbreak Emergency Operation Center files. The objectives were to describe the characteristics, management and outcome of a methanol outbreak using Active Case Finding to trace the victims. Results A total of 694 patients presented to emergency departments in Rafsanjan after public announcement of the outbreak between 29th May and 3rd June 2013. The announcement was mainly performed via short message service (SMS) and local radio broadcasting. A total of 361 cases were observed and managed in Rafsanjan and 333 were transferred to other cities. Seventy-five and 100 patients underwent hemodialysis (HD), retrospectively. The main indication for HD was refractory metabolic acidosis. Eight patients expired due to the intoxication. Except for the deceased cases, no serum methanol level was available. Conclusion In developing countries, where diagnostic resources are limited, use of active case finding and developing national guidelines can help in the management of large outbreaks of methanol poisonings. © 2014 The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: [email protected]

Relationship between esophageal clinical symptoms and manometry findings in patients with esophageal motility disorders: A cross-sectional study

Background: Manometry is the gold-standard diagnostic test for motility disorders in the esophagus. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The diagnostic value of particular esophageal clinical symptoms among patients suspected of esophageal motor disorders (EMDs) is still unknown. The aim of this study was to explore the sensitivity, specificity, and predictive accuracy of presenting esophageal symptoms between abnormal and normal esophageal manometry findings. Methods: We conducted a cross-sectional study of 623 patients aged 11-80 years. Data were collected from clinical examinations as well as patient questionnaires. The sensitivity, specificity, and accuracy were calculated after high-resolution manometry plots were reviewed according to the most recent Chicago Criteria. Results: The clinical symptoms were not sensitive enough to discriminate between EMDs. Nevertheless, dysphagia, noncardiac chest pain, hoarseness, vomiting, and weight loss had high specificity and high accuracy to distinguish EMDs from normal findings. Regurgitation and heartburn did not have good accuracy for the diagnosis of EMDs. Conclusion: Clinical symptoms are not reliable enough to discriminate between EMDs. Clinical symptoms can, however, discriminate between normal findings and EMDs, especially achalasia