A Rare Presentation of Carnitine Palmitoyltransferase II (CPT-2) Deficiency With Normal Acylcarnitine Profile in a 10-Year-Old Boy With Muscle Weakness and Bilateral Hearing Loss

Carnitine palmitoyltransferase II (CPT-2) deficiency is a rare and autosomal recessive disorder of long-chains fatty acids oxidation. Here, we report a 10-year-old boy with a bilateral hearing loss and a myopathic form of CPT II deficiency which was confirmed under molecular genetic test analysis. He was admitted to our hospital with unexplained headache, vomiting, and fever. Furthermore, he developed seizures, muscle weakness, neck stiffness and pain, mild respiratory distress, and icteric appearance. The laboratory test results also showed sever elevated levels of lactate dehydrogenase (LDH) and Creatine phosphokinase (CPK). He had also icteric appearance with unexplained hyperbilirubinemia. Further examinations revealed normal heart, liver without neurological disorders. Muscle pathological examination reported normal pathology without neuromuscular and mitochondrial disorders and storage diseases. Finally, molecular test analysis with next generation sequencing (NGS) revealed a homozygous pathogenic variant in the CPT-II gene, c.338C>T p. (Ser113Leu) which was correlated to CPT-II deficiency fatty acid oxidation disorder. Furthermore, we identified a homozygous pathogenic variant in the ADGRV1 gene, c.15736C>T p.(Arg5246*), which suggest the Usher syndrome type 2C and the reason for sensorineural hearing loss in this case. Our finding indicates that CPT-II can be associated with multiple symptoms and clinical features. Therefore, evaluation of CPT-II deficiency with molecular test analysis may be helpful in cases with unexplained icteric appearance, muscle weakness and rhabdomyolysis.&nbsp

Desarrollar el instrumento de evaluación de la Organización Mundial de la Salud para el sistema de salud mental (WHO-AIMS) en IRÁN

Introduction: The tool for assessing the Mental Health System of the World Health Organization has been used in different countries in different countries,by which examining the mental health system and identifying their problems along with finding out the instrumental problems are done simoltaneously. Purpose: this study was conducted in order to develop the means of evaluating the mental health system organization of the world health organization in iran. Method: This research is based on the implementation, analytical, and in terms of variables, combination (qualitative and quantitative), and purposeful, exploratory, and from the perspective of the result, an application that was carried out in six phases. Phase I: Review of texts that have been used to recognize the status of countries Different and Iran. Phase II: The status of mental health system in Khuzestan province was investigated and the problems of mental health system and instrumental problems were determined. Phase III: weaknesses and strengths of the mental health system evaluation tool were surveyed in Khuzestan province, Phase IV: To identify the key components of the WHO Mental Health Routing Program and the 2013-2015 operational plan for development of tools, in the fifth phase: The proposed components were embedded in each main field of the tool, and the content of the content validity and content validity index were evaluated by the experts. Result: Finally, 11 main components were identified and 95 questions were designed for them, which in the sixth phase these questions Mental Health Managers were given an exploratory and confirmatory factor analysis and identified their main factors and their impact on the development of the Mental Health Assessment System of the World Health Organization. Using PLS software from 11 components and 95 suggested questions, 6 factors influencing The development of tools has been identified whose impact coefficients include: Leadership and Governance (0.972), mental health and e-service use (0.929), Policy and Legislative Framework (0.697), status analysis (0.613), mental health services pattern for common disorders (0.413), mental health promotion services (0.259). Conclusion: The development of the Mental Health Assessment Tool of the World Health Organization in Iran will help identify the mental health gap and, with regard to the problems, will be the best pattern for providing mental health servicesIntroducción: La herramienta para evaluar el Sistema de Salud Mental de la Organización Mundial de la Salud se ha utilizado en diferentes países en diferentes países, mediante el cual el examen del sistema de salud mental y la identificación de sus problemas junto con el descubrimiento de los problemas instrumentales se realizan de forma simultánea. Propósito: este estudio se realizó con el fin de desarrollar los medios para evaluar la organización del sistema de salud mental de la organización mundial de la salud en Irán. Método: Esta investigación se basa en la implementación, analítica y en términos de variables, combinación (cualitativa y cuantitativa), y con una finalidad, exploratoria y, desde la perspectiva del resultado, una aplicación que se realizó en seis fases. Fase I: Revisión de textos que se han utilizado para reconocer el estado de países diferentes e Irán. Fase II: Se investigó el estado del sistema de salud mental en la provincia de Khuzestan y se determinaron los problemas del sistema de salud mental y los problemas instrumentales. Fase III: se examinaron las debilidades y fortalezas de la herramienta de evaluación del sistema de salud mental en la provincia de Khuzestan, Fase IV: para identificar los componentes clave del Programa de Enrutamiento de Salud Mental de la OMS y el plan operativo 2013-2015 para el desarrollo de herramientas, en la quinta fase : Los componentes propuestos se integraron en cada campo principal de la herramienta, y los expertos evaluaron el contenido de la validez de contenido y el índice de validez de contenido. Resultado: Finalmente, se identificaron 11 componentes principales y se diseñaron 95 preguntas para ellos, que en la sexta fase a estas Gerentes de Salud Mental se les realizó un análisis factorial exploratorio y confirmatorio e identificaron sus factores principales y su impacto en el desarrollo de la Salud Mental Sistema de evaluación de la Organización Mundial de la Salud. Utilizando el software PLS de 11 componentes y 95 preguntas sugeridas, se han identificado 6 factores que influyen El desarrollo de herramientas cuyos coeficientes de impacto incluyen: Liderazgo y Gobernanza (0,972), salud mental y uso de servicios electrónicos (0,929), Marco Político y Legislativo (0.697), análisis de estado (0.613), patrón de servicios de salud mental para trastornos comunes (0,413), servicios de promoción de salud mental (0,259). Conclusión: El desarrollo de la Herramienta de evaluación de salud mental de la Organización Mundial de la Salud en Irán ayudará a identificar la brecha de salud mental y, con respecto a los problemas, será el mejor patrón para proporcionar servicios de salud mental

Relationship between Person-Organization Fit and Performance Indices of Public Hospitals Affiliated with Qazvin University of Medical Sciences in Iran

Background: Person-organization fit is an effective factor for recruiting, selection, and retention of human resources in organizations. Objective: This study examined the correlation between person-organization fit and performance indicators used in healthcare in the hospitals affiliated with Qazvin University of Medical Sciences (QUMS). Methods: This descriptive cross-sectional study was conducted in 2014. A total of 324 employees were randomly selected from among the study population comprising the staff of teaching hospitals affiliated with QUMS. The sample size was distributed between the hospitals using the class-ratio method. Data were collected using person-organization fit (Scroggins) questionnaires, and their validity and reliability were evaluated. Data analysis was done using Spearman-Pearson correlation, chi-square, and Kruskal-Wallis tests. Results: In terms of values fit, personality fit, and skills, knowledge, and ability fit, hospital C ranked first among the hospitals tested with average ratings of 175.99, 195.53, 199.49, respectively. Significant relationships were found between person-organization fit and patients admitted per bed, median duration of patient stay, and crude mortality rate. No significant relationships were found between person-organization fit and the performance indicators of bed circulation and bed occupancy rate (p ≤ 0.05). Conclusion: In order to show an association between person-organization fit and the performance indicators, more efficient use of resources and improved efficiency is suggested. Policymakers must pay more attention to person-organization fit during recruitment, selection, and assignment of staff

Developing a Model for the Establishment of Pre-Hospital Emergency Medicine Bases in the Northern Provinces of Iran

BACKGROUND: The faster and more accurately Pre-Hospital Emergency Medicine as the first line of care and treatment is done, the less the mortality and disability rates are.AIM: The present study is an attempt to design a model for the establishment of pre-hospital emergency bases in the northern provinces of Iran.METHODS: This quantitative-qualitative (mixed-method) research was conducted in two parts: First, using the literature review, interviews with experts in the field, and a comparative study, the most important factors affecting the establishment were extracted. Second, the obtained data were employed to formulate the development model and to design the questionnaire. The required data for factor analysis were collected through a questionnaire distributed among 200 operational personnel in January 2018. The results were analyzed using confirmatory factor analysis and multiple regression.RESULTS: Five components were identified after the exploratory factor analysis and Varimax with an eigenvalue larger than 1. The effect coefficients calculated for human resources components, service speed, and information and communication system were 0.935, 0.765 and 0.752, respectively. The obtained goodness of fit was very close to one, indicating the one-dimensional strength of the model. The highest parameter estimation in this model was allocated to the human component as 0.935, which has a significant correlation with other components.CONCLUSIONS: In order to reduce the response time, more attention should be paid to the allocation of budget and organizational roles, education, participation from government departments, establishment of an independent medical emergency organization, and appropriate accessibility to reduce the rates of mortality and morbidity

Diseño del Modelo de Gestión de Servicios de Salud Mental

Introduction: Having mental health is necessary for the growth and prosperity of humans and as a result of the growth of societies.Objectives: The purpose of this study was to design a mental health management model in Iran.Methods: In this exploratory study, a review study was first performed to analyze the current state of mental health services in Iran and the world. Countries were selected to compare mental health management with Iran in 6 domains. 311 faculty members with mental health were completed by completing a questionnaire with 50 items in the study. Using the factor analysis, the final model was explained. Results: The effective domains in Iranian mental health services management were named in 8 areas: Mental Health in Particular, Key Centers and Task-Shifting, Human Resources and Specialists Training, Psychological Services for Children and Adolescents, Financial Resources and Hospital Services, Mental Health in PHC and Primary medical services, Policy-Making and Human Rights, Monitoring and Control, Community-Based Services. Conclusions: The proposed model of mental health services management in Iran consists of 8 domains, which is a comprehensive and multidimensional concept. Paying attention to its factors can lead to the successful management of mental health services in Iran.Objetivo: Tener salud mental es necesario para el crecimiento y la prosperidad de los humanos y como resultado del crecimiento de las sociedades. Objetivos: El propósito de este estudio fue diseñar un modelo de gestión de salud mental en Irán. Material y Métodos: en este estudio exploratorio, primero se realizó un estudio de revisión para analizar el estado actual de los servicios de salud mental en Irán y el mundo. Los países fueron seleccionados para comparar la gestión de la salud mental con Irán en 6 dominios. Se completaron 311 profesores con salud mental completando un cuestionario con 50 ítems en el estudio. Utilizando el análisis factorial, se explicó el modelo final. Resultados: Los dominios efectivos en la gestión de los servicios de salud mental iraníes se nombraron en 8 áreas: salud mental en particular, centros clave y cambio de tareas, capacitación de recursos humanos y especialistas, servicios psicológicos para niños y adolescentes, recursos financieros y servicios hospitalarios, salud mental en APS y servicios médicos primarios, formulación de políticas y derechos humanos, monitoreo y control, servicios comunitarios. Conclusiones: El modelo propuesto de gestión de servicios de salud mental en Irán consta de 8 dominios, que es un concepto integral y multidimensional. Prestar atención a sus factores puede conducir a la gestión exitosa de los servicios de salud mental en Irán

Ethylene Response Factor Sl-ERF.B.3 Is Responsive to Abiotic Stresses and Mediates Salt and Cold Stress Response Regulation in Tomato

Sl-ERF.B.3 (Solanum lycopersicum ethylene response factor B.3) gene encodes for a tomato transcription factor of the ERF (ethylene responsive factor) family. Our results of real-time RT-PCR showed that Sl-ERF.B.3 is an abiotic stress responsive gene, which is induced by cold, heat, and flooding, but downregulated by salinity and drought. To get more insight into the role of Sl-ERF.B.3 in plant response to separate salinity and cold, a comparative study between wild type and two Sl-ERF.B.3 antisense transgenic tomato lines was achieved. Compared with wild type, Sl-ERF.B.3 antisense transgenic plants exhibited a salt stress dependent growth inhibition. This inhibition was significantly enhanced in shoots but reduced in roots, leading to an increased root to shoot ratio. Furthermore, the cold stress essay clearly revealed that introducing antisense Sl-ERF.B.3 in transgenic tomato plants reduces their cell injury and enhances their tolerance against 14 d of cold stress. All these results suggest that Sl-ERF.B.3 gene is involved in plant response to abiotic stresses and may play a role in the layout of stress symptoms under cold stress and in growth regulation under salinity

Factors Affecting Development of Medical Tourism Industry in West Azerbaijan Province of Iran

Background: The market of medical tourism is considered as a revenue and competitive industry throughout the world, it is also regarded as a novel field of the advanced tourism. Therefore, most of the developing countries have focused on the medical tourism industry and they are planning for implementing it. In 2016, the present research was conducted with the main objective of designing a model for medical tourism development in West Azerbaijan province of Iran.Methods: This study is a cross-sectional study. The statistical population consisted of 40 interviewees who were selected via targeted sampling. The scholar-made questionnaire and studies of the Ricafort and Kazemi were employed as the tools of collecting data. The PLS software was utilized for analyzing data.Results: The results showed that two main factors, including hospital selection with an impact factor of 0.143 and West Azerbaijan province selection with impact factor of 0.466 had both direct and significant impact on development of medical tourism. The impact factor of all approaches on development of medical tourism was obtained positive and significant (P≤0.001).Conclusions: For development of medical tourism industry in West Azerbaijan province, attention to elements such as the appropriate conditions to attract medical tourism, according to political, legal, and regional economic development is effective

Factors Affecting Development of Medical Tourism Industry in West Azerbaijan Province of Iran

Background: The market of medical tourism is considered as a revenue and competitive industry throughout the world, it is also regarded as a novel field of the advanced tourism. Therefore, most of the developing countries have focused on the medical tourism industry and they are planning for implementing it. In 2016, the present research was conducted with the main objective of designing a model for medical tourism development in West Azerbaijan province of Iran.Methods: This study is a cross-sectional study. The statistical population consisted of 40 interviewees who were selected via targeted sampling. The scholar-made questionnaire and studies of the Ricafort and Kazemi were employed as the tools of collecting data. The PLS software was utilized for analyzing data.Results: The results showed that two main factors, including hospital selection with an impact factor of 0.143 and West Azerbaijan province selection with impact factor of 0.466 had both direct and significant impact on development of medical tourism. The impact factor of all approaches on development of medical tourism was obtained positive and significant (P≤0.001).Conclusions: For development of medical tourism industry in West Azerbaijan province, attention to elements such as the appropriate conditions to attract medical tourism, according to political, legal, and regional economic development is effective

Investigating the Time Indicators of the Emergency Department and Design a Management Dashboard for it

سابقه و هدف: سرعت ارائه خدمات در مراكز درماني به خصوص اورژانس، در جهت كاستن از مرگ و مير و معلوليت ها از اهميت ويژه اي برخوردار است. مديريت زمان در ارائه خدمات درماني بسيار حياتي و کوتاهي از آن مي تواند جان بيماران را به خطر اندازد. يكي از مهمترين شاخص هايي كه در ارزيابي مراكز اورژانس به كار گرفته مي شود مدت زمان انتظار بيماران براي دريافت خدمات تشخيصي درماني مي باشد. اين مطالعه به منظور بررسي شاخص هاي زمان سنجي و طراحي داشبورد مديريتي در يک مرکز تخصصي قلب در شهر تهران در سال1397 انجام شد. روش بررسي: اين پژوهش از نوع، مقطعي بود که در آن شاخص هاي زماني اورژانس وزارت بهداشت مورد بررسي قرار گرفت.کليه داده هاي مربوطه در بخش اورژانس در يک بيمارستان شهر تهران سال1397گردآوري شد. سپس طراحي و ايجاد داشبورد براساس داده هاي شاخص هاي تعيين شده در بخش اورژانس با استفاده از نرم افزار Qlick View بارگذاري شده و نمايش عملکرد اين بخش ارائه گرديد. اين مطالعه در کميته اخلاق دانشگاه بررسي و مجوز اخلاق کسب کرد. يافته ها: با انجام مطالعه ي حاضر، 6 شاخص زمان سنجي اورژانس مورد بررسي قرار گرفت. سپس با توجه به اطلاعات بدست آمده داشبورد مربوطه طراحي گرديد. نتيجه گيري: كاهش طول مدت اقامت در بخش اورژانس، منجر به افزايش رضايتمندي بيماران و به طور بالقوه صرفه جويي در هزينه‌ها مي‌شود. در واقع، رسالت اصلي اورژانس، ارايه خدمات با كيفيت بالا در كوتاه‌ترين زمان ممکن است. توقف طولاني مدت در اورژانس، امکان ارايه خدمات به ساير بيماران نيازمند به فوريت‌هاي پزشکي را كاهش مي‌دهد و اين امر موجب نارضايتي بيماران و افزايش تلفات ناشي از حوادث خواهد شد. How to cite this article: Mayelafshar M, Noohi F, Riahi L, Nikravan A.Investigating the Time Indicators of the Emergency Department and Design a Management Dashboard for it. J Saf Promot Inj Prev. 2020; 8(2):86-96.Background and Objectives: The speed of service delivery in medical centers, especially emergencies, is of particular importance in reducing mortality and disability. Time management in providing vital and short-term health care services can endanger patients' lives. One of the most important indicators used in the evaluation of emergency centers is the waiting time for patients to receive diagnostic and treatment services. This study was conducted in 1397 in order to study the timing indicators and design of the management dashboard in a specialized heart center in Tehran. Materials and Methods: This type of research is a section in which the emergency time indicators of the Ministry of Health were examined. All the relevant data in the emergency department was collected in a hospital in Tehran in 1397. Then, the design and creation of the dashboard was loaded based on the data of the indicators specified in the emergency department using QuickView software and the performance of this section was presented. Results: In the present study, six emergency timing indicators were examined. Then, according to the information obtained, the relevant dashboard was designed. Conclusion: Reducing the length of stay in the emergency department leads to increased patient satisfaction and potentially cost savings. The main mission of the emergency is to providing high quality services in the shortest possible time. Prolonged emergency stops reduced the possibility of providing services to other patients in need of emergency medical care, which can lead to patient dissatisfaction and increased casualties. How to cite this article: Mayelafshar M, Noohi F, Riahi L, Nikravan A.Investigating the Time Indicators of the Emergency Department and Design a Management Dashboard for it. J Saf Promot Inj Prev. 2020; 8(2):86-96

Identifying the Factors Affecting the Management of Addiction Treatment Clinics: A Qualitative Study

Background: Due to the expansion of addiction treatment clinics and the costs that these clinics incur on the government and the families of addicts, monitoring the performance of these clinics and the need to pay attention to the principles of management, efficiency, and effectiveness is essential. Objectives: The present study was conducted to identify the factors affecting the management of addiction treatment clinics. Methods: The present study is a descriptive-applied and cross-sectional study conducted in 2019. Experts and academic experts have been considered as the research community, and 18 people were selected as the research sample by the purposeful snowball method. Data collection tools were the review of relevant national and international documents as well as semi-structured exploratory interviews. Finally, after collecting information from the interview sections and reviewing the sources, the data foundation and coding methods (open, axial, and selective) were used to classify the data.Results: The findings of the study showed that the effective factors in the management of addiction treatment clinics are dimensions such as organization, planning, control, guidance as well as leadership and treatment management. Conclusion: According to the findings of this study, it can be concluded that the effective factors in the management of addiction treatment clinics can be a good basis to evaluate managers so that the policies and programs of the organization can be upgraded, modified, and reviewed