A 41-Year-Old Woman with Seizure

The patient was a 41 year old woman that was brought to the emergency department (ED) by her husband following seizure. According to the relatives accompanying her, the seizure was of tonic-clonic type, had occurred one hour before presentation to ED, and had lasted 3 minutes. The patient had been drowsy for about 15 minutes after the end of the seizure. She had no history of head trauma and did not mention headache, nausea and vomiting, fever, vision problems or others. On presentation, amnesia regarding the things that happened was evident. In her history, she had a generalized tonic-clonic seizure 4 years back, regarding which she had not done proper follow up for taking necessary diagnostic measures and had not been treated with anti-epileptic medication. She had a history of surgery for removing cold thyroid nodule 20 years ago and was under calcium treatment for 15 years but she had decided to stop taking her medications since 5 year ago. She did not have a history of alcohol or drug abuse. The patient was conscious and awake on presentation and did not have any specific clinical complaints. Her vital signs on presentation were as follows:Blood Pressure = 120/70mmHg, Pulse Rate = 68/minute, Respiratory Rate = 16/minute, O2saturation= 98% at air room, Oral Temperature= 37°C, and bedside blood sugar in the normal range.In head and neck examination, the surgery scar was seen in the thyroid region. Examination of the thyroid also showed a nodular surface in palpation. Examination of the heart, lungs, abdomen and extremities did not have pathologic findings. Neurologic examinations including evaluation of cranial nerves, sense and power of the muscles, cerebellar examination and deep tendon reflexes were normal. Based on the opinion of the in-charge physician, anti-epileptic drugs were not prescribed at this stage. Laboratory tests including complete blood cell count, liver function tests (LFT), and level of blood sugar (BS), sodium, potassium, calcium, phosphorus, magnesium, urea and creatinine electrolytes were ordered. Considering the full consciousness of the patient and stability of vital signs and clinical examinations, by taking safety measures and accompanied by a nurse, the patient was referred to the radiology unit to undergo a brain computed tomography (CT) scan, the results of which are shown in figure 1

Comparison of quality of work life in rural family physicians and other general physicians in Iran

Background: Job satisfaction of physicians in family physician team is considered as one of the important factors for health system. The aim of the preent study was to compare the quality of work life (QoWL) in rural family physicians and general physicians with private clinics in Kurdistan province.Methods: A cross-sectional study was conducted among 103 general physicians including 50 rural family physicians and 53 general physicians with private clinics in Kurdistan province in 2016. The data were collected using QoWL questionnaire and analyzed using SPSS, v. 16. Descriptive statistics including frequency, percentage, mean, and standard deviation (SD) were used to describe the data and to examine the relationship between the variables, T-test was run.Results: The QoWL of rural family physicians with a mean of 55 (SD = 7.6) was higher than average scores. But QoWL of other general physicians with a mean of 47.7 (SD = 13.5) was lower than average scores. The results of t-test showed that there was a significant difference between QoWL of family physicians and other general physicians (t = 82.3, p = 0.001). In rural family physicians, there is a significant association between the QoWL and gender (t=2.7, P = 0.009) as well as native status (t=2.53, P = 0.004). In general physicians with private clinics, the QoWL of native physicians was higher than that of non-native physicians (t = 4.3, P = 0.001).Conclusion: The QoWL of rural family physicians is better than that of others general physicians, even though it is unsatisfactory in both studied groups. Therefore, improving the QoWL of rural family physicians, especially female and non-native rural family physicians, is recommended because promoting the rural family physicians' satisfaction can decrease the likelihood of turnover, and thus increase service quality and responsiveness, as a goal of the health system

Does Freedom Matter for Sustainable Economic Development? New Evidence from Spatial Econometric Analysis

Achieving sustainable economic development is always considered one of the main economic goals of countries. Therefore, researchers are interested in presenting new econometric models for more accurate identification of factors affecting economic growth. The current study evaluates the impact of various aspects of freedom (economic freedom, press freedom, civil freedom, and political rights) and an aggregated freedom index on economic growth in European countries from 2000 to 2019 using spatial panel econometric techniques. In addition, the effects of variables such as FDI, financial development (FD), human capital (HC), and capital stock on economic growth are examined. The findings of this research confirm the existence of spatial autocorrelation in economic growth. The results reveal that civil liberties, economic and press freedom, and aggregated freedom boost economic growth, whereas political rights have no significant effect on economic growth. Furthermore, the econometric model results indicate that FDI, FD, HC, and capital stock are positively and significantly associated with economic growth. This research is expected to provide policymakers with a thorough understanding of how to implement the best policies in European countries to achieve sustainable economic development

Comparison of the Modulated Effects of Tretinoin and Calcitriol Treated Mesenchymal Stem Cell Supernatant on Macrophage Functions

Background: According to a number of studies, calcitriol and tretinoin are able to regulate differentiation as well as the growth and of mesenchymal stem cells (MSCs). Nevertheless, the relationship between the supernatant of macrophage and mesenchymal stem cells is still under investigation. In the present work, a comparison is made between the modulated impacts of calcitriol and tretinoin treated mesenchymal stem cell supernatant on macrophage functions. Materials and Methods: The isolation of mesenchymal stem cells was done using mouse bone marrow and the various concentrations of calcitriol (200 and 400 nM) and tretinoin (25, 50, and 100 nM) were used to pulse MSCs for 48 h. Macrophages were then applied to co-culture the supernatant of MSCs for 4 hr. Consequently, macrophages were assessed for respiratory burst. Results:  Based on the obtained results, supernatant of bone marrow‐derived MSCs pulsed with calcitriol and tretinoin can have the potential for decreasing the respiratory burst of macrophages considerably in comparison with the control group.  Conclusion: The anti‐inflammatory M2 macrophage polarization can be accelerated using calcitriol and tretinoin by mesenchymal stem cells

Evaluating the Feasibility of Poly (3-hydroxybutyrate-co-3-hydroxyvalerate) Co-Biopolymer Production from Rice Wastewater by Azohydromonas lata

 Background and objective: Biopolymers are environmental friendly, non-toxic renewable alternatives for conventional synthetic polymers. Rice wastewater contains high biochemical and chemical oxygen demands and organic contents mainly in form of starch which can cause serious environmental problems, while, it can be used as a potentially low-cost substrate for biopolymer production. The objective of the current study was to investigate the ability of Azohydromonas lata to produce poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (P3HB-co-P3HV) from rice wastewater in a batch system.Material and methods: Aspergillus niger was first used to hydrolyze the starch content of rice wastewater to fermentable soluble sugars. Then, the bacterium Azohydromonas lata was cultured in hydrolyzed wastewater at various C: N: P ratios to produce biopolymers. So, effects of different nitrogen and carbon sources on P (3HB) and P (3HV) contents at a C: N: P ratio of 100:4:1 were assessed.Results and conclusion: This study showed that Azohydromonas lata was able to produce poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (P3HB-co-P3HV) from rice wastewater in the presence of simple carbon sources and under limited nutrient conditions, especially phosphorus. The highest content of P (3HB) was achieved when ammonium sulphate was used as nitrogen source at a C: N: P ratio of 100:4:1. The highest recorded cell dry mass and biopolymer concentration were 4.64 and 2.8 g l-1 respectively, at a P(3HB) content in biomass of 60%  w w-1. Results indicated that phosphorus and nitrogen limitations could significantly affect P (3HB) production. In general, rice wastewater is a potential alternative for carbon sources such as glucose and maltose in polyhydroxybutyrate production.Conflict of interest: The authors declare no conflict of interest

Causal Adversarial Perturbations for Individual Fairness and Robustness in Heterogeneous Data Spaces

As responsible AI gains importance in machine learning algorithms, properties such as fairness, adversarial robustness, and causality have received considerable attention in recent years. However, despite their individual significance, there remains a critical gap in simultaneously exploring and integrating these properties. In this paper, we propose a novel approach that examines the relationship between individual fairness, adversarial robustness, and structural causal models in heterogeneous data spaces, particularly when dealing with discrete sensitive attributes. We use causal structural models and sensitive attributes to create a fair metric and apply it to measure semantic similarity among individuals. By introducing a novel causal adversarial perturbation and applying adversarial training, we create a new regularizer that combines individual fairness, causality, and robustness in the classifier. Our method is evaluated on both real-world and synthetic datasets, demonstrating its effectiveness in achieving an accurate classifier that simultaneously exhibits fairness, adversarial robustness, and causal awareness

Birth prevalence of genital anomalies among males conceived by intracytoplasmic sperm injection cycles: A cross-sectional study

Background: Several studies have been conducted worldwide to evaluate the prevalence and relative risks of congenital anomalies associated with assisted reproductive technology cycles; however, there is limited data in Iran. Objective: To investigate male genital anomalies among live births from assisted reproductive technology. Materials and Methods: This cross-sectional study was conducted on children born after intracytoplasmic sperm injection (ICSI) at Royan Institute, Tehran, Iran from April 2013-December 2015. The prevalence of male genitalia disorders that included hypospadias, epispadias, cryptorchidism, micropenis, and vanishing testis were reported. The relationship between the cause of infertility and type of embryo transfer (fresh or frozen), gestational age at birth (term or preterm), and birth weight with these male genitalia anomalies were evaluated. Results: In total, 4409 pregnant women were followed after their ICSI cycles to evaluate genitalia anomalies in their children. Out of 5608 live births, 2614 (46.61%) newborns were male, of which 14 cases (0.54%) had genital anomalies. The prevalence of various anomalies were cryptorchidism (0.34%), hypospadias (0.038%), micropenis (0.038%), vanishing testis (0.038%), and epispadias (0.077%). No relationship was found between the cause of infertility, type of embryo transfer (fresh or frozen), gestational age at birth (term or preterm), and male genital malformation (p = 0.33, p = 0.66, and p = 0.62, respectively). Conclusion: The prevalence of each male genital anomaly after the ICSI cycle was rare and less than 0.5%; however, no significant infertility-related factor was observed with these anomalies. Key words: Cryptorchidism, Hypospadias, Microinjections, Prevalence, Reproductive techniques, Urogenital abnormalitie

Relationship between Quality of Work Life of Medical Staff and Quality of Patient Care

Background: Nowadays, quality of patient care is one of the major and important concerns of health care delivery which is extremely dependent on the medical staff. Objectives: The purpose of this study was to investigate the relationship between Quality of Work Life (QWL) and quality of patient care. Methods: This study was a descriptive-analytic study based on correlation which was conducted in the educational hospitals of Kermanshah. A total of 320 medical staffs were selected for the study. Quality of Work Life and Quality of Patient Care questionnaires were used to collect the data. For data analysis, descriptive statistics, person correlation coefficient, t-test and multivariate regression were used by using SPSS16 Results: Data analysis showed that the Quality of Work Life of medical staffs was in a medium level. Our findings indicate that there is a significant, negative relationship between stress at work and quality of patient care (P-value=0.001 & r=-0.247) and there is a significant, positive relationship between control & job satisfaction and quality of patient care (P-value=0.001 & r=0.217). Results of multivariate regression analysis showed that stress at work net account for 6% of the variance of the quality of patient care. Conclusion: Focusing on improving the working conditions of medical staffs can be incredibly useful in increasing the quality of health care

Investigation on microbial deterioration of exquisite collection of old manuscripts in Iran

Background and Objectives: The present study was to evaluate the microbial diversity inhabiting biodeteriorated precious manuscripts of the Holy Quran placed in one of the repositories of the Library of Astan Quds Razavi (AQR), and its relation to the air microbial diversity. Materials and Methods: Three non-invasive sampling methods, culture-based techniques, and molecular identification were used to investigate the microorganisms involved in deterioration. To investigate the air microbial quality and its role in the destruction of the repository objects, air samples were taken from six different points inside the repository. Biomodeling studies were designed to verify the impact of microbial isolates. Results: 14 fungal isolates were obtained from three deteriorated ancient Quran manuscripts. The most frequently isolated fungi from the different substrates were Aspergillus spp. and Penicillium spp. In the air, the prevalence across fungal genera was rather uniform. 30 species of the identified bacteria were collected from three manuscripts. The results obtained in the present study showed that the bacterial species from different genera belonged to three phyla: Proteobacteria (n = 2), Actinobacteria (n = 4), and Firmicutes (n = 24). The paper strips were artificially colonized by Aspergillus sp., Penicillium chrysogenum, and Talaromyces diversus producing spots which were visible to the naked eye. In the scanning electron microscopy images, the colonization of the selected organism was observed. Conclusion: The characteristics of paper inoculated artificially with these microbial isolates confirmed their deteriorating effects. Based on molecular identification, the similarity of fungal and bacterial species isolated from both substrates and air samples suggest the direct relationship between microorganisms from the air and those isolated from the manuscripts

اولویت بندی نیازهای آموزشی کارکنان مراکز اورژانس پیش بیمارستانی و بیمارستانی در خصوص سوانح و حوادث ترافیکی: تبیین نظرات متخصصان و گروه های هدف

Background and Aims: It is essential to recognize the current situation and training needs for staff in the field of traffic accident prevention in order to organize suitable training programs. This study was conducted to assess the educational needs of pre-hospital and hospital personnel with respect to traffic accidents in 2015.Materials and methods: This combined study was conducted in three phases-collection of qualitative data, design and validation of the needs assessment questionnaire, and a cross-sectional study. In the first stage, the assessment questionnaire was prepared using semi-structured interviews. The content validityof the questionnaire was then conducted by an expert panel. Finally, educational needs of the target group were assessed in a cross-sectional study using the questionnaire. All stages of this research were conducted ethically.Results: Results showed that the most important educational needs of pre-hospital centers were CPR training, opening up airways, checking the status of victim awareness, and ABC training courses. The three priorities of hospital emergency centers included ways to deal with special cases (such as amputation), advanced burn life support, and advanced trauma life support (ATLS) with the same degree of importance and self-care as in a road accident course.Conclusion: The identified priorities point out that it is necessary to formulate and implement educational programs to enhance the skills of pre-hospital and hospital staff.زمینه و اهداف: برای برنامه ریزیهای آموزشی مناسب در زمینه پیشگیری و برخورد با سوانح و حوادث ترافیکی، شناخت وضعیت و نیازهای  آموزشی کارکنان ارائه دهنده این خدمت ضروری است. پژوهش حاضر با هدف نیازسنجی آموزشی پرسنل و مدیران مراکز پیش بیمارستانی وبیمارستانی در خصوص سوانح و حوادث ترافیکی در سال 1395 انجام شد. مواد و روشها: این پژوهش به صورت ترکیبی  در سه مرحله جمع آوری دادههای کیفی، طراحي و اعتبار سنجی ابزار نیاازسنجي و مطالعه مقطعي انجام گردید. در مرحله اول با استفاده از مصاحبه های نیمه ساختاریافته، چارچوبی از ابزار نیازسنجی به دست آمد و در مرحله بعد روایی صوری و محتوایی ابزار با استفاده از پنل متخصصان صورت گرفت و در مرحله آخر نیازهای آموزشی گروههای هدف با استفاده از ابزار بدست آمده در یک مطالعه مقطعی مشخص گردید. تمام مراحل تحقیق با رعایت اخلاق پژوهش و با کسب رضایت شرکت کنندگان انجام گردید. یافته ها : مهمترین نیاز آموزشی مراکز پیش بیمارستانی، به ترتیب، دوره آموزشی CPR، دوره آموزشی بررسی وضعیت هوشیاری مصدوم و باز کردن راههای هوایی و دوره آموزشی ABC بود. همچنین سه اولویت اول مراکز اورژانس بیمارستانی به ترتیب، دوره آموزشی نحوه برخورد با موارد خاص مثل قطع عضو، دوره های آموزشی سوختگیهای پیشرفته وATLS اقدامات پیشرفته برخورد با بیماران ترومایی  با درجه اهمیت یکسان و دوره آموزشی خود مراقبتی در سوانح و حوادث جادهای بود. نتیجه گیری: با توجه به اولویتهای استخراج شده، لازم است از طرق تدون و برگزاري برنامه های آموزشي به ارتقاء مهارتهای پرسنل مراکز پیش بیمارستانی و بیمارستانی اقدام نمود