Prevalence of Depression and Personality Disorders in the Beginning and End of Emergency Medicine Residency Program; a Prospective Cross Sectional Study

Introduction: Emergency medicine physicians are constantly under psychological trauma due to encountering critically ill patients, mortality, and violence, which can negatively affect their mental and physical health. The present study was performed with the aim of determining the rate of depression and personality disorders in first-year emergency medicine residents and comparing it with the time they reach the 3rd year. Methods: In the present prospective cross-sectional study, emergency medicine residents working in multiple teaching hospitals were included via census method and evaluated regarding the rate of depression and personality disorders using the standard MMPI-2 questionnaire upon admission to the program and graduation and their status regarding the evaluated disorders were compared between the 2 phases of evaluation. Results: 99 residents with the mean age of 33.93 ± 5.92 years were evaluated. 85 (85.85%) rated their interest in their discipline as moderate to high. The rates of stress (p = 0.020), anxiety (p < 0.001), and hypomania (p = 0.015) had significantly increased during the 3 years and psychasthenia rate had decreased significantly during this time (p = 0.002). Changes in the prevalence of other disorders on the third year compared to the year of admission to emergency medicine program were not significant. Conclusion: Considering the results of the present study, it seems that paying more attention to mental problems and decreasing environmental stressors of medical residents, especially emergency medicine residents, should be among the priorities of managers and policymakers of this discipline

Seizure Prevalence and Its Related Factors in Tramadol Intoxication; a Brief Report

Introduction: Seizure is known to be a serious complication of tramadol consumption even in its therapeutic doses. The aim of this study was to determine the prevalence of seizure and its related factors in tramadol intoxicated patients referred to emergency department (ED). Methods: In this cross-sectional study, all individuals, admitted to ED following tramadol intoxication were divided into two groups based on the presence or absence of seizures. Demographic data as well as clinical, electroencephalogram and imaging findings were compared between the two groups using SPSS software version 22. Results: 167 patients with the median age of 23 (13-45) years were studied (85% male). Seizure was seen in 97 (58.0%) cases. Risk of seizure had increased 3.7 times in patients with a history of seizure (OR: 3.71 Cl 95%: 1.17 - 11.76). Tramadol dose was significantly higher in patients who had seizure more than once (Median: 2800 IQR: 1800-4000), compared to those who had one seizure episode (Median: 850 IQR: 1800-400) (p <0.0001). Conclusion: Based on the findings of this study, history of seizure increased the risk of seizure in patients taking tramadol, and the increase in dose correlated with a significant increase in seizure frequency

Upward Altitudinal Shifts in Habitat Suitability of Mountain Vipers since the Last Glacial Maximum

We determined the effects of past and future climate changes on the distribution of the Montivipera raddei species complex (MRC) that contains rare and endangered viper species limited to Iran, Turkey and Armenia. We also investigated the current distribution of MRC to locate unidentified isolated populations as well as to evaluate the effectiveness of the current network of protected areas for their conservation. Present distribution of MRC was modeled based on ecological variables and model performance was evaluated by field visits. Some individuals at the newly identified populations showed uncommon morphological characteristics. The distribution map of MRC derived through modeling was then compared with the distribution of protected areas in the region. We estimated the effectiveness of the current protected area network to be 10%, which would be sufficient for conserving this group of species, provided adequate management policies and practices are employed. We further modeled the distribution of MRC in the past (21,000 years ago) and under two scenarios in the future (to 2070). These models indicated that climatic changes probably have been responsible for an upward shift in suitable habitats of MRC since the Last Glacial Maximum, leading to isolation of allopatric populations. Distribution will probably become much more restricted in the future as a result of the current rate of global warming. We conclude that climate change most likely played a major role in determining the distribution pattern of MRC, restricting allopatric populations to mountaintops due to habitat alterations. This long-term isolation has facilitated unique local adaptations among MRC populations, which requires further investigation. The suitable habitat patches identified through modeling constitute optimized solutions for inclusion in the network of protected areas in the region

Phylogeography of two Iranian reptiles (Montivipera raddei complex and Ophisops elegans) and implication for conservation

Les espèces de haute altitude (Sky-Islands) sont parmi les taxons les plus sensibles aux changements environnementaux et une meilleure connaissance de ces espèces (répartition, groupes génétiques, histoire d’évolution, etc.) est indispensable afin de définir les unités adaptées pour la conservation. Cette thèse a porté sur l’analyse moléculaire de deux gènes mitochondriaux (Cyt b et ND4) chez le groupe d’espèces Montivipera raddei et un gène mitochondrial (COI) chez l’Ophisops elegans dans les montagnes d’Iran qui sont des centres d’endémisme importants pour les reptiles. En me basant sur les données génétiques, je propose de considérer toutes les montivipère d’Iran comme une seule espèce ; Montivipera raddei comprenant trois sous-espèces ; Montivipera raddei albicornuta (nord du Zagros, Zanjan et nord-ouest de l’Iran jusqu’en Turquie), Montivipera raddei latifii (Alborz), et Montivipera raddei kuhrangica (centre du Zagros). Les temps de divergences obtenus entre les clades de montivipères semblent montrer des changements de la connectivité des populations pendant le Pléistocène qui résulte de l’effet fort des oscillations climatiques durant cette époque, notamment pendant les interglaciaires. Ce travail a aussi révélé une grande diversité génétique au sein des clades iraniens d’ophisops élégant ce qui pose la question de l’existence d’espèces/sous-espèces cryptiques en Iran. Finalement, ce travail a permis de définir des ESU pour les montivipères et l’ophisops élégant et notamment je propose que toutes les populations isolées du groupe d’espèces M. raddei et d’O. elegans montrant des haplotypes propres soient considérées comme des ESU pour la conservation.High-altitude species (Sky-Islands) are among the most sensitive taxa to environmental changes and a better knowledge of these species (distribution, genetic groups, evolutionary history, etc.) is essential in order to define the adapted units for the conversation. This thesis focused on the molecular analysis of two mitochondrial genes (Cyt b and ND4) in the Montivipera raddei (Radde's Rock Viper) species group and a mitochondrial gene (COI) in Ophisops elegans (Snake-Eyed Lizard) in the mountains of Iran, which are important centers of endemism for reptiles. Based on the genetic data, I propose to consider all the Iranian montivipers as one species; Montivipera raddei comprising three subspecies; Montivipera raddei albicornuta (north of Zagros, Zanjan and northwestern Iran to Turkey), Montivipera raddei latifii (Alborz), and Montivipera raddei kuhrangica (central Zagros). The times of divergence between the clades of montivipers seem to show changes in the connectivity of populations during the Pleistocene, which results from the strong, effect of climatic oscillations during this period, especially during interglacial periods. This work also revealed a great genetic diversity within the Iranian clades of snake-eyed lizard, which raises the question of the existence of cryptic species / subspecies in Iran. Finally, this work made it possible to define ESUs for montivipers and snake-eyed lizards. In particular, I propose that all isolated populations of the M. raddei species group and O. elegans showing specific haplotypes to be considered as ESUs for conservation

Eco-geographic factors used for modeling the distribution of <i>Montivipera raddei</i> species complex in Iran, Turkey and Armenia.

<p>Variables in bold type were used in climate change scenarios and were prepared with 2.5 arc-second resolution.</p

Discrimination capacity and classification accuracy criteria for cross-validated Maxent models of <i>Montivipera raddei</i> species complex in Iran, Turkey and Armenia used for evaluating the performance of Ecological Niche Models (ENMs).

<p>Mean omission error refers to maximum training sensitivity plus specificity logistic threshold.</p

Percentage cover of climate-only models within the probability classes for the distribution of <i>Montivipera raddei</i> species complex in Iran, Turkey and Armenia.

<p>Percentage cover of climate-only models within the probability classes for the distribution of <i>Montivipera raddei</i> species complex in Iran, Turkey and Armenia.</p

Altitudinal distribution of <i>Montivipera raddei</i> species complex habitats in the past, present and future (A). Annual mean temperature of accessible habitats for <i>Montivipera raddei</i> species complex within different climate niche models (B). Annual mean temperature of <i>Montivipera raddei</i> species complex habitats in the past, present and future (C).

<p>Average values were calculated for cells occurring within probability classes of different climate niche models.</p

Predicted distribution models of <i>Montivipera raddei</i> species complex in Iran, Turkey and Armenia.

<p>Models are based on the CCSM (a) and MIROC (b) for the past, present condition (c), and 2.6 (d) and 8.5 (e) scenarios of CCSM that describe mitigation and high emission scenarios of future anthropogenic climate change, respectively. Red colour shows areas with higher probability of occurrence. MESS encompasses non-analogous climate conditions with reference to the training background range of the baseline model.</p