Spatial-time analysis of cardiovascular emergency medical requests: enlightening policy and practice

Background: Response time to cardiovascular emergency medical requests is an important indicator in reducing cardiovascular disease (CVD) -related mortality. This study aimed to visualize the spatial-time distribution of response time, scene time, and call-to-hospital time of these emergency requests. We also identified patterns of clusters of CVD-related calls. Methods: This cross-sectional study was conducted in Mashhad, north-eastern Iran, between August 2017 and December 2019. The response time to every CVD-related emergency medical request call was computed using spatial and classical statistical analyses. The Anselin Local Moran's I was performed to identify potential clusters in the patterns of CVD-related calls, response time, call-to-hospital arrival time, and scene-to-hospital arrival time at small area level (neighborhood level) in Mashhad, Iran. Results: There were 84,239 CVD-related emergency request calls, 61.64% of which resulted in the transport of patients to clinical centers by EMS, while 2.62% of callers (a total of 2218 persons) died before EMS arrival. The number of CVD-related emergency calls increased by almost 7% between 2017 and 2018, and by 19% between 2017 and 2019. The peak time for calls was between 9 p.m. and 1 a.m., and the lowest number of calls were recorded between 3 a.m. and 9 a.m. Saturday was the busiest day of the week in terms of call volume. There were statistically significant clusters in the pattern of CVD-related calls in the south-eastern region of Mashhad. Further, we found a large spatial variation in scene-to-hospital arrival time and call-to-hospital arrival time in the area under study. Conclusion: The use of geographical information systems and spatial analyses in modelling and quantifying EMS response time provides a new vein of knowledge for decision makers in emergency services management. Spatial as well as temporal clustering of EMS calls were present in the study area. The reasons for clustering of unfavorable time indices for EMS response requires further exploration. This approach enables policymakers to design tailored interventions to improve response time and reduce CVD-related mortality.This study was financially sponsored by Mashhad University of Medical Sciences (Project grant: 980861)

(Tables 1-15) Morphometric characteristics of the genus Hinia (Nassariidae, Gastropoda) in the Tertiary of northwest Germany

The genus Hinia is divided in 4 subgenera; other subgenera are not represented in the area studied. It was possible to find criteria for a better discrimination of the highly variable species H. (Hinia) schlotheimi and H. (Hinia) turbinella. The species "fuchsi" has been placed in the synonymy of H. (Hinia) turbinella. The species H. (Hinia) schlotheimi (BEYRICH) and H. (Telasco) schroederi (KAUTSKY) have been united under the name H. (Hinia) schlotheimi. The easily distinguishable species H. (Tritonella) tenuistriata and H. (Hinia) sulcata belong to two different genera. H. (Tritonella) cimbrica andersoni of the Viol- and Katzheide-Beds (Reinbek-stage) is separable from the population found in the Hemmoor-stage, it turned out to be a valuable guide subspecies for the Reinbek-stage. The species H. (Tritonella) serraticosta, H. (Tritonella) catulli, H. (Hinia) holsatica, and H. (Telasco) syltensis are all similar in respect to shape and ornamentation. Criteria have been found for a better discrimination of these species. The species contabulata, effusa and seminodifera described by SPEYER (1864), turned out to be contogenetic stages of H. (Tritonella) pygmaea. H. (Tritonella) cavata, previously described from the Tertiary of the North sea area, was proven to be absent from the area investigated. The forms described under that name, belong to H. (Tritonella) woodwardi

The rate of antibiotic utilization in Iranian under 5-year-old children with acute respiratory tract illness: A nationwide community-based study

Background: To investigate the prevalence of antibiotic usage in children aged <5 years with acute respiratory tract illness (ARTI) in Iran. Materials and Methods: Data were collected from a national health survey conducted in 2010 (Iran′s Multiple Indicator Demographic and Health Survey). Participants of this cross-sectional study were selected by multistage stratified cluster-random sampling from 31 provinces of Iran. Parents of children with <5 years of age responded to questions about the occurrence of any cough during the previous 2 weeks, referral to private/governmental/other health care systems, and utilization of any oral/injection form of antibiotics. Data were analyzed using SPSS software18. The chi-square test was used to determine antibiotic consumption in various gender and residency groups and also a place of residence with the referral health care system. Results: Of the 9345 children under 5 years who participated in the study, 1506 cases (16.2%) had ARTI during 2 weeks prior to the interview, in whom 1143 (75.9%) were referred to urban or rural health care centers (43.4 vs. 30.4%; P < 0.001). Antibiotics were utilized by 715 (62.6%) of affected children. Injection formulations were used for 150 (13.1%) patients. The frequency of receiving antibiotics was higher in urban than in rural inhabitants (66.0% vs. 57.7%; P < 0.05). Conclusion: The prevalence of total and injection antibiotics usage in children <5 years with ARTI is alarmingly high in Iran. Therefore, interventions to reduce antibiotic use are urgently needed

Seroepidemiology of Toxoplasma gondii infection in Isfahan province, central Iran: A population based study

Background: Toxoplasmosis is a worldwide infection. Most studies on toxoplasmosis are in women in child bearing ages. We conducted an epidemiological survey on the population of the Isfahan Province to identify characteristics of the individuals associated with seropositivity. Methods: In a cross sectional study, 599 serum samples were randomly collected for seroepidemiology of Hepatitis A and E, and were also used for titration of IgG anti-toxoplasma gondii antibody by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Data were analyzed using SPSS software 15 . Chi square and Fisher exact tests were employed to examine antibody status in different age, gender, education and residency groups. Results: The overall prevalence was 41.4% (248/599). There was a statistical significant association between seroprevalence with age, education, and gender (p < 0.05) but not with residency state. The peak age for acquisition of the infection in females was 20-29 and in males 20-39 years old. Conclusions: Results of current study showed a moderate prevalence of toxoplasma gondii infection. However higher seroconversion rate in active social and reproductive ages, females and low educated individuals necessitate active preventive programs in these high risk groups

Persistence of endothelial cell damage late after Kawasaki disease in patients without coronary artery complications

Background: Recent studies proposed an increased risk of atherosclerosis in patients with a history of Kawasaki disease. This study aimed to investigate the persistence of vascular injury after an acute phase of the Kawasaki disease. Materials and Methods: We determined the number of circulating endothelial cells (CEC) in the peripheral blood of 13 patients with a history of Kawasaki disease within four to ten years, in comparison with 13 healthy relative controls. The CECs were counted as CD146+/CD34 + cells by the standard flow cytometry technique, and the independent t-test was employed to compare the mean number of CECs in the two groups. Results: The mean number of CECs was significantly higher in patients than in controls (12 ± 3.03 vs. 2.38 ± 0.87, respectively, P < 0.001). Conclusion: This study elucidates the persistence of vascular injury late after Kawasaki disease. This finding suggests that prolonged administration of vascular anti-inflammatory agents might be beneficial for preventing atherosclerosis in the subsequent years, in these patients

Toxoplasma gondii infection in women of childbearing age of Isfahan, Iran: A population-based study

Background: We conducted an epidemiological survey on seroprevalence of toxoplasma infection in women of childbearing age in Isfahan Province. Materials and Methods: In a cross-sectional study in 2010, 217 women in the age range of 10-50 years were randomly selected. The blood samples examined for the presence of IgG anti-Toxoplasma gondii antibody by a commercial ELISA kit (Dia-Pro, Milan, Italy). Chi-square and Fisher′s exact tests were employed to examine the antibody status in different age, marriage, education, and residence groups. Results: The overall prevalence was 47.5% (103/217). The peak age of infection acquisition was in the range 30-40 years in rural areas and 20-30 years in urban districts. There was no significant association between residence, education, and marriage groups on the one hand and chance of T. gondii infection on the other hand. Conclusions: The findings of the study suggest a moderate prevalence of T. gondii infection, but a high prevalence in ages of high reproductive activities