A 21-year-old Pregnant Trauma Patient with Asymptomatic Fat Embolism; a Case Report

Introduction: Fat embolism syndrome (FES) is most often associated with orthopedic trauma that typically presents 24–72 hours after the trauma with a classic triad. Only few cases of fat embolism due to lower extremity venous system had been reported. Case presentation: The current case report presents a pregnant woman who was referred to our emergency department with bilateral femoral open fracture. After detecting fetal demise by abdominopelvic ultrasound, an area of fat density in right external iliac vein was detected in abdominopelvic contrast enhanced computed tomography (CT) scan which was considered as the probable diagnosis of fat embolism. While the patient did not show signs and symptoms of FES, the fat embolism was confirmed in further evaluations. Conclusion: In summary, although detection of fat embolus in CT scan in the emergency department is very rare, evaluation of lower extremity venous system in a posttraumatic patient seems to be crucial because early diagnosis of fat embolism can help the clinicians to prevent FES

A 21-year-old Pregnant Trauma Patient with Asymptomatic Fat Embolism; a Case Report

Introduction: Fat embolism syndrome (FES) is most often associated with orthopedic trauma that typically presents 24–72 hours after the trauma with a classic triad. Only few cases of fat embolism due to lower extremity venous system had been reported. Case presentation: The current case report presents a pregnant woman who was referred to our emergency department with bilateral femoral open fracture. After detecting fetal demise by abdominopelvic ultrasound, an area of fat density in right external iliac vein was detected in abdominopelvic contrast enhanced computed tomography (CT) scan which was considered as the probable diagnosis of fat embolism. While the patient did not show signs and symptoms of FES, the fat embolism was confirmed in further evaluations. Conclusion: In summary, although detection of fat embolus in CT scan in the emergency department is very rare, evaluation of lower extremity venous system in a posttraumatic patient seems to be crucial because early diagnosis of fat embolism can help the clinicians to prevent FES

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

The Challenges of Implementing Family Physician and Rural Insurance Policies in Kerman Province, Iran: A Qualitative Study

Background: Assessment of policies and determining their challenges are necessary to improve and reform health systems. Family physician and rural insurance policies have been the second important phase of changes in health services provided in Iranian villages and towns with populations under 20,000. This study aimed to identify the challenges of implementing these policies in Kerman Province, Iran. Methods: This qualitative study was carried out in 2010 through semi-structured focus group discussions and document reviews. Purposive sampling was used to select 10 policy executives from Kerman University of Medical Sciences and Medical Insurance Organization and family physicians. Data from the focus groups and document reviews was analyzed by content analysis. Results: The challenges were categorized into seven main groups including improper motivation initiatives, inadequate educational effectiveness, poor comprehensiveness in instructions and arrangements, deficient per capita resources, low efficacy of health information management systems, lack of a suitable referral chain, and inadequate cultural infrastructure. Conclusion: The success of every policy depends on periodical assessments of its implementation challenges. Considering the expansion of family physician policy in larger urban areas, more attention should be paid by the national and local authorities to eliminate the identified barriers and constraints. Keywords: Family medicine, Rural insurance, Assessment, Challenges, Policy implementation, Ira

Evaluation of organic solvents effects on physiological parameters of exposed people in industry

Introduction: One of the most common chemical exposures is organic solvents in the workplace and some of them are toxic to human health. The purpose of this study was to determine the organic solvents effect on physiological parameters of exposed people in industry. Methods: This study was descriptive - analytical and in terms of time cross-sectional that the 50 workers were employed in the home appliance industry. The data were collected in three stages: 1) through observation and interview 2) reviewing periodic examinations of workers 3) measure the concentration of BTEX. Descriptive and analytical statistics analysis was performed with SPSS software version 20. Results: According to the results obtained spirometry parameters in the exposed group (FEV1=89.62±10.53) is lower than the non-exposed (FEV1=97.32±8.92) while the average liver enzymes in exposed workers (SGOT= 29.56±9.49 and SGPT=38.67±17.5) was higher than non-exposed (SGOT= 17.5±6.38 and SGPT=21.11±8). Conclusion: Long-term exposure to BTEX leads to a reduction in respiratory capacity, and increase liver enzymes. So, with proper engineering and management controls and periodic examination of such problems can be prevented in workers

Mechanisms Underlying the Dual Effect of Polyunsaturated Fatty Acid Analogs on Kv7.1

Polyunsaturated fatty acid (PUFA) analogs represent a new class of potential anti-arrhythmic K(V)7.1 and K(V)7.1+KCNE1 channel activators. In this study, we describe dual independent activating effects of negatively charged PUFA analogs on K(V)7.1 and K(V)7.1+KCNE1 that are dependent on discrete channel motifs. PUFA analogs are critically dependent on K326 in S6 of K(V)7.1 to increase the maximum conductance and critically dependent on specific S4 arginines in K(V)7.1 to shift the voltage dependence of channel opening toward negative voltages. Our findings provide insights into how K(V)7.1+KCNE1 activators may interact electrostatically both with the pore domain and the voltage-sensing domain to augment channel activity. We believe that the molecular understanding of how PUFA analogs induce dual independent activating effects is an important step toward the development of effective anti-arrhythmic drugs that target K(V)7.1 channels.Funding Agencies|National Institutes of Health [R01GM109762, R01HL131461]; American Heart Association [14GRNT20380041]; Swedish Society for Medical Research; Swedish Research Council [2017-02040]; Magnus Bergvalls Foundation; Lions Foundation; Center for Systems Neurobiology at Linkoping University; Swedish National Infrastructure for Computing [SNIC 2016/1-543, 2017/1-290]</p