Gray area; a novel strategy to confront COVID-19 in emergency departments

Introduction: Coronavirus disease 2019 (COVID-19) pandemic, affects almost every aspect of human life. To confront this crisis, a separate ward called gray area was designed for emergency departments (EDs) and applied at the provincial level in East-Azerbaijan, Iran. This study aimed to evaluate the effectiveness of this project, increase the serviceability and segregation of the location of infected patients, and show how feasible and fruitful it can be. Methods: This study is an analytical study. The statistical data collection from 39 hospitals was performed between 20 March to 21 September 2020. Descriptive Statistics as well as correlation coefficients were calculated using the 26th version of IBM SPSS. Results: Among 77489 COVID-19 patients admitted to the EDs, approximately 0.38% of patients died in EDs. 22.63% of EDs area was allocated to COVID-19 patients and 70.46% of ED nurses, worked in the gray area. There was no significant correlation between area, number of patients, number of nurses, number of shifts of nurses, number of nurses for each patient, number of nurse shifts for each patient, and area for each patient with mortality rate and rates of disposition in 6 and 12 hours. Conclusion: Gray area is an appropriate strategy to confront COVID-19 in EDs and if more studies approve these results, this strategy can be used to confront this pandemic and future similar conditions in resource-limited countries

Middle Paleolithic Lithic Industry from Qaleh Kurd Cave, Qazvin Province,Iran

This paper focuses on the lithic finds from two seasons of excavations at Qaleh Kurd (QK), a cave site inwestern Central Plateau. Through sedimentological studies, Holocene and Pleistocene deposits were identifiedduring the excavations. Analysis of sedimentary context and the spatial distribution of the faunal remains andlithics suggested that the Pleistocene deposits at QK split into three sub-periods. Statistical analysis based on thelithic techno-typology confirmed such suggestion with the lithics featuring Middle Paleolithic (MP) affinities inall phases. The cross-sequence comparisons of QK’s lithics with the Zagros and Central Plateau MP assemblagessuggested stronger affinities of QK with the former. The overall characteristics of the QK tool kit consist of ascraper-rich, flake-base typology, low frequency of denticulate and notch, the abundance of points, applicationof Levallois technique, frequent signs of direct percussion, minimal preparation of platform, and the presence ofintense retouching and rejuvenating the edges

The Efficacy of General Anesthesia with Sevoflurane for Pain Management in Neonates and Infants with Idiopathic Clubfoot Treated with Ponseti Technique and Percutaneous Achilles Tenotomy

Background: Idiopathic clubfoot deformity is a relatively common congenital pediatric foot deformity. A percutaneous Achilles tenotomy (PAT) is required to correct the equinus deformity as it is the most resistant component of clubfoot deformity. Although this procedure is mainly performed with local anesthesia, performing this procedure with general anesthesia has significant advantages. Aims: The purpose of this study was to compare the safety and efficacy of post-procedural pain management of PAT in the treatment of clubfoot with the Ponseti method when performed in a clinic setting with local anesthetic or under general anesthesia Methods: This is a multicentric prospective observational evaluation on children less than one year of age with idiopathic clubfoot whom referred for Ponseti casting and PAT. This procedure was done in the control group with local anesthesia and in the intervention group with Sevoflurane mask 8% (MAC 2) and maintenance of anesthesia with Sevoflurane mask 4% (N2O/O2, 50%). The neonatal infant pain scale (NIPS), the amount of milk, and mood changes were evaluated as a criterion to measure the pain level. Results: NIPS score in the intervention group was significantly lower than the control group. Children in the intervention group consume significantly more milk than the control group. Furthermore, 76% of children in the intervention group were classified as "calm," 24% as "relatively restless," and no child was classified as "severely restless." While in the control group, 54% of children were classified as "severely restless," and the remaining 46% as "relatively restless." Conclusion: Our result showed that using general anesthesia to perform achillotomy in the treatment of clubfoot in children could be associated with less pain in these patients and without significant complications

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Cytogenetique des lymphocytes chez des malades atteints de leucemie lymphoiede chronique-B

SIGLET 55204 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

The Effect of Estradiol on Renal Function in Reversible and Irreversible Unilateral Ureteral Obstruction in Rats

BACKGROUND: The ureteral obstruction (UO) is the most common clinical disorders. This study was designed to investigate the renoprotective effect of estradiol in unilateral UO (UUO) and reversible UUO (RUUO). METHODS: Eighty-four ovareictomized Wistar rats were assigned into 14 groups. Group 1 was sham operated group. All the groups 2-14 were subject to UUO, however they received additional treatments. Group 2-4 received test substances (vehicle, 0.1 or 0.05 mg/kg of estradiol) and sacrificed after 3 days. Group 5-7 received test substances and after 3 days followed by RUUO (obstruction removal) and after one day post RUUO were sacrificed. Group 8-9 followed by RUUO after 3 days and simultaneously received estradiol and after one day post RUUO were sacrificed. Group 10-12 followed by RUUO after 3 days and simultaneously received test substances and after 3 days post RUUO were sacrificed. Group 13-14 received test substances followed by RUUO and received test substances again and after 3 days post RUUO were sacrificed. RESULTS: The estradiol reduced body weight significantly (p<0.05) in UUO, and the uterus weight (UW) increased significantly by estradiol (p<0.05). The increased serum levels of blood urea nitrogen (BUN) and creatinine (Cr), and kidney weight (KW) induced by UUO (p<0.05) were not attenuated by estradiol. Estradiol treatment did not alter the levels of BUN, Cr, KW, Cr clearance (CrCl), urine sodium excretion and urine flow when compared with control. CONCLUSION: Although the protective role of estradiol in cardiovascular system is well accepted, however our findings suggest that its protection during UUO or after RUUO in renal system cannot be certain. KEYWORDS: estradiol, ureteral obstruction, renal function, ra

Successful outcome in managing of aluminum phosphide poisoning

Aluminum phosphide (ALP) is a potent lethal substance, that use for agriculture purpose, as a pesticide. this substance may use for suicide, and it will kill the patient rapidly. we want to report a patient who use ALP for suicide purpose and was managed quickly in the emergency department and he became alive

Effect of Platelet-Rich Plasma on CCl4-Induced Chronic Liver Injury in Male Rats

Platelet-rich plasma (PRP) has been of great concern to the scientists and doctors who are involved in wound healing and regenerative medicine which focuses on repairing and replacing damaged cells and tissues. Growth factors of platelet-rich plasma are cost-effective, available, and is more stable than recombinant human growth factors. Given these valuable properties, we decided to assess the effect of PRP on CCl4-induced hepatotoxicity on rats. The rats received CCl4 (1 mL/kg, i.p. 1 : 1 in olive oil) twice per week for 8 weeks. Five weeks after CCl4 injection, the rats also received PRP (0.5 mL/kg, s.c.) two days a week for three weeks. Twenty-four hours after last CCl4 injection, the animals bled and their livers dissected for biochemical and histopathological studies. Blood analysis was performed to evaluate enzyme activity. The results showed that PRP itself was not toxic for liver and could protect the liver from CCl4-induced histological damages and attenuated oxidative stress by increase in glutathione content and decrease in lipid peroxidative marker of liver tissue. The results of the present study lend support to our beliefs in hepatoprotective effects of PRP