Peg-Interferon Alfa 2-b Related Cellulitis in a 40 Years Man

Background: Pegylated interferon and ribavirin are currently one of the accepted treatment for chronic Hepatitis C. Dermatologic complications of interferon have been reported, but to date a few cases of bacterial cellulitis; a rare and severe complication, have been published. Cellulitis is a common infectious process affecting the skin and subcutaneous tissues which results in significant morbidity and holds considerable healthcare costs.Cases Report: Herein, we report a case of chronic hepatitis C genotype 1a who was on medication since 8 weeks prior to developing leg cellulitis, an uncommon pegylated interferon injection site. Considering no other possible risk factors were found to be in favor of bacterial cellulitis, our case is unique in its kind. Some reports reveal necrotizing vasculitis as basis for cutaneous lesions, which could be due to the high concentrations of drug at the injection site, a toxic effect of the diluents, or an immunological reaction.Conclusion: According to the latter mechanism patients could develop bacterial cellulitis in their different organs. Conclusively, we propose the hypothesis of a possible association between cellulitis to occur at any site as the complication of pegylated interferon Alfa 2b and would highlight the role of a careful skin examination that could be an asset in preventing local skin infections

DONUT-hole: DONUT Sparsification by Harnessing Knowledge and Optimizing Learning Efficiency

This paper introduces DONUT-hole, a sparse OCR-free visual document understanding (VDU) model that addresses the limitations of its predecessor model, dubbed DONUT. The DONUT model, leveraging a transformer architecture, overcoming the challenges of separate optical character recognition (OCR) and visual semantic understanding (VSU) components. However, its deployment in production environments and edge devices is hindered by high memory and computational demands, particularly in large-scale request services. To overcome these challenges, we propose an optimization strategy based on knowledge distillation and model pruning. Our paradigm to produce DONUT-hole, reduces the model denisty by 54\% while preserving performance. We also achieve a global representational similarity index between DONUT and DONUT-hole based on centered kernel alignment (CKA) metric of 0.79. Moreover, we evaluate the effectiveness of DONUT-hole in the document image key information extraction (KIE) task, highlighting its potential for developing more efficient VDU systems for logistic companies

Investigating Aspects of Siavash Ties with Mehr Rituals

The story of Siavash has an old mythological theme, and hence one can consider him a mythic-ritual person whose study of various aspects of his story calls for the recognition of ancient rituals. The present research has examined Siavash in ancient texts and Shahnameh with a descriptive-analytical method. Contrary to the views of previous scholars, this paper concludes that Siavash has had the signs of Mitraism within himself. Such signs contain different features than common ones. Incidentally, these signs are those that are not part of Mehr rituals, but are its distinctive features. These signs revolve around the issues of belief in action and wisdom, and those aspects of religion that emphasize the role of intellectuals showed Siavash as the owner of Farah meaning the follower of religion and country, relating to Mehr rituals. So, a number of Siavash’s traits and mythical events around him should be found in beliefs such as believing in theism (Farah bavari), a pass-by-fire test, a horse and a Teshter in ancient mythologies, the source of the alliance, the righteousness, skillfulness in archery and vendetta are beliefs of the worshipers of Mehr

Country Pharmaceutical Situation Based on World Health Organization Indicators: Evidence from an Upper-Middle Income Country

Evaluating the performance of national authorities has a pivotal role in the development of evidence-based policymaking. Regarding the complexity of the pharmaceutical sector and its severe impacts on public health, Food and Drug Administrations' (FDA) performance should be evaluated at regular intervals. This study aims to depict a comprehensive picture of the Iranian pharmaceutical situation and its structural gaps. In this cross-sectional descriptive study, inspired by indicators proposed by the world health organization (WHO), a checklist was developed with six component topics and 239 indicators. These topics considered the existence and performance of six critical structures, including national drug policy (NDP), regulatory system, medicine supply system, medicine financing, production and trade, and rational use of drugs (RUD). Afterward, the translation validity and then face and content validity of the research tool was confirmed by relevant experts. The data were collected by referring to official documents, reports, and critical informants in the Iranian Food and Drug Administration (IRFDA). According to the WHO indicators, the scores for structures of IRFDA are 80% in NDP, 61.5% in the regulatory system, 64.7% in the medicines supply system, 84.8% in medicines financing, and 60% in production, and trade, and 71.7% in RUD. Considering the status of structures and processes, IRFDA should attempt to provide an action plan commensurate with the NDP. Besides, it should modify the regulations regarding its responsibilities and authorities, develop transparency and accountability in its offices, publish a national essential medicines list, and revise motivational and punitive policies to create RUD

Quantifying Supplier Induced Demand Caused by the 2014-Health Reform Plan

The Health Reform Plan was initiated in 2014 aiming to increase health utilization and to reduce the out-of-pocket payment. The plan was criticized for its inflationary effects and also its health induced demand. This study examines the induced demand hypothesis using the health datasets of the year  2008 (before the reform) and the year 2015 (after the reform). The data is collected every four years by the National Institute of Health Research. As the control group, we consider individuals who have accessed to medical knowledge among their family members and are less exposed to the asymmetric information; thus they can be considered as the control group for whom there is no induced demand.  Individuals without medical knowledge are more likely to be exposed to induced demand by physicians, and are considered as the treatment group. We use Difference-in-Difference methodology. The robustness of results are tested using variety of subgroups and controlling for many observation. Results indicate that individuals without medical knowledge has an average of 10% more referrals compared to those who have medical knowledge. Also, their per capita cost has been increased by 54%, which is equivalent to extra 10650 tomans after the reform. Our results confirm that the reform has significantly induced demand