Third-degree heart block in thalassemia major: A case report

Background: First and second-degree heart blocks are partly common rhythm disorders in thalassemic patients but complete heart block is a very rare complication of iron overload cardiomyopathy. Case Presentation: This 15-year-old boy, a known case of major β-thalassemia was admitted to our emergency unit with dyspnea and cough because of decompensated heart failure. The electrocardiogram showed complete heart block with junctional escape rhythm. Interestingly, his previous electrocardiogram taken 2 months earlier, had some PVC and second degree, Mobitz type 1 (Wenckebach) heart block. After improvement of dyspnea and control of blood pressure in normal range, the patient was referred to ER. A dual-chamber permanent pacemaker was implanted and his symptoms improved, but he died 24 days after discharge from hospital. Conclusion: We present a rare case of complete heart block after a second-degree (Mobitz 1) heart block that was due to severe iron overload cardiomyopathy. © 2012 by Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences

Cardiovascular autonomic neuropathy among non- insulin dependent diabetics patients

Background and Objective: Cardiovascular autonomic neuropathy (CAN) is the most common and important type of diabetic autonomic neuropathy. Silent myocardial infarction, respiratory failure and increased mortality are the outcomes of CAN. This study was carried out to screen the cardiovascular autonomic neuropathy in non- insulin dependent diabetics patients. Method: This descriptive - analytic study was carried on 70 (22 males, 48 females) non- insulin dependent diabetics’ patients. Resting heart rate, heart rate variability, orthostatic changes in heart rate, blood pressure and corrected QT interval were recorded for each subject. The final findings were categorized as follow: 0=normal, 1=borderline and 2=CAN positive. Results: 10 (14.3%) of patients were normal, 35 (50%) of patients were borderline and 25 (35.7%) of patients were considered cardiovascular autonomic neuropathy positive. There was significant differences between duration of diabetes and three CAN scores (P<0.05). The systolic blood pressure alterations showed the maximum correlation with CAN scores (r=0.509). Conclusion: In our study, the rate of cardiovascular autonomic neuropathy was higher than other reports. The most important risk factor for cardiovascular autonomic neuropathy was more than 10 years history of diabetes mellitus. Keywords: Diabetes mellitus, Cardiovascular autonomic neuropathy, Hypertensio

TyG index and insulin resistance in beta-thalassemia

Insulin resistance (IR) underlies some glucose metabolism abnormalities in thalassemia major. Recently, triglyceride glucose index (TyG) has been proposed for evaluating insulin resistance as a simple, low cost, and accessible tool. In this study, the TyG index were studied for IR monitoring in beta-thalassemia major (βTM) patients. The participants were 90 βTM patients on chronic regular transfusion therapy. The TyG index was computed based on fasting plasma glucose (FPG) and triglyceride (TG). The time gap between the first and the second TyG index survey (TyG.1 and TyG.2) was 2 years. The agreement between TyG and HOMA-IR were studied with the extension of limit of agreement (LOA). We included 90 patients 53.3 % men (n = 48). Among them, 14.4 % (14.6 % male, 14.3 % female) had impaired fasting glucose level (e.g., 100–125 mg/dl) at first test. It rose to 37.8 % (27.1 % male, 50 % female) during 2 years. Based on TyG.1, the 34.4 % of patients was detected as IR cases. After 2 years, the percent of IR based on TyG.2 was 82.2 %. The mean differences between TyG.1 and TyG.2 and their differences from the considered cutoff values were significant (P < 0.001). The prediction limits between TyG and HOMA-IR had good agreement. These data may suggest the use of TyG index for detection/monitoring of IR in βTM patients. © 2015, Research Society for Study of Diabetes in India

Determination of the best canopy gap area on the basis of soil characteristics using the Analytical Hierarchy Process (AHP)

The assessment of canopy gap areas on the basis of soil characteristics in forest ecosystems could be one of benefit points for management of forests. This research was conducted in 20 ha areas of Experimental Forest Station of Tarbiat Modares University that is located in a temperate forest of Mazandaran province in the north of Iran. Twenty one canopy gaps with different areas were found in studied areas and classified as small (85.12 m2), medium (325.21 m2), large (512.11 m2) and very large (723.85 m 2) gaps. These areas classes of canopy gaps were assessed with respect to nine criteria (soil pH, carbon to nitrogen ratio, cation exchange capacity, phosphorus, potassium, calcium, nitrogen mineralization, microbial respiration and earthworm's biomass). Soil samples (0-45 cm depth from the gap center and edge positions) were measured in the laboratory. The Analytical Hierarchy Process (AHP) was used for assessment of canopy gap areas. This method is widely used the Multiple Criteria Decision Support (MCDS) method and perhaps the most popular in many fields, including natural resource management, especially in forest sciences. Results of AHP indicate that the maximum of local priority belongs to small areas of canopy gaps when considering all soil characteristics. However, medium, large and very large canopy gap areas have priorities, respectively. The calculated overall priority showed that with respect to considered criterias, small and medium gap areas have higher, more ideal condition in comparison to large and very large areas. AHP results emphasise that considering soil characteristics canopy gap areas should be less than 400 m2 in Hyrcanian forests of Iran. Also, AHP can be introduced as an effective instrument in decision-making processes for investment planning and prioritization in compliance with environmental regulations

Investigating fish purchase patterns and preferences among the consumers of Sari

The present study aimed at looking into the fish consumption preferences and purchase patterns among 266 households of Sari in order to identify the fish market at Mazandaran province. To do so, a questionnaire was provided to be administered among consumers to state their preferences towards the type of fish species, purchased forms of fish as well as fish purchasing pattern in their family. Descriptive statistics as well as referential analysis was conducted through Friedman Test. Results showed that meat consumption priority among the households of Sari constituted the consumption of poultry meat, lamb, fish and beef, respectively. As to the investigation of fish purchase pattern, it was that almost two-thirds of households in Sari bought fish less than once a month and only a few percentage of them (4.1 percent) purchased them on a weekly basis. It was also revealed that consumers in Sari prefer marine fish more than farmed fish, and cold-water fish more than warm-water fish. Fresh, live and canned fish were the preferred forms of purchase for the consumers in Sari, and other forms of fish such as frozen, smoked and salted fish (total 7.9 percent) were rarely preferred by the consumers. Findings of the current research can contribute to powerful decision-making of companies and suppliers in terms of which product should be provided to the market for more sale. Therefore, recognizing the needs and desires of consumers and understanding their purchase behavior are effective steps to meet their expectations and ultimately increasing fish consumption

Unilateral presentation of Vogt-Koyanagi-Harada syndrome

Purpose: To report a case of acute Vogt-Koyanagi-Harada (VKH) disease with unilateral clinical manifestations followed by late fellow eye involvement. Case Report: This case report reviews the 12-month follow-up observation of a 44-year old woman who presented to the emergency department with unilateral progressive and painless visual blurring. Ophthalmoscopic findings, best-corrected visual acuity (BCVA), fluorescein angiography (FAG), enhanced-depth optical coherence tomography (EDI-OCT), indocyanine green angiography, and response to treatment were evaluated. Her BCVA was 20/50 (logMAR: 0.4) in the right eye and 20/20 (logMAR: 0) in the left eye. Eye examination revealed optic disc swelling and multiple serous retinal detachments in the right eye and a normal left eye. She had headache, dysacusia, and mild hearing problem. Her past ocular and drug histories were unremarkable. Retinal imaging revealed characteristic features of VKH in the right eye. All laboratory testing results were inconclusive. VA and OCT findings significantly improved following the treatment with methylprednisolone 1 g/day continued by tapering dose of oral prednisolone. Two months after the presentation and during prednisolone tapering, VA of the left eye decreased and fundus examination revealed multiple serous retinal detachments in this eye. Conclusion: Ophthalmologists should recognize unilateral and asymmetrical VKH disease with subtle systemic involvement. © 2020 JOURNAL OF OPHTHALMIC AND VISION RESEARCH | PUBLISHED BY KNOWLEDGE

More efficient lateral load patterns for seismic design of steel moment resisting frames

The preliminary design of building structures is normally based on the equivalent lateral forces provided in seismic design guidelines. The height-wise distribution of these loads is predominantly based on elastic vibration modes. However, as structures exceed their elastic limits in severe earthquakes, these design load patterns may not necessarily lead to efficient distribution of strength within the structures. To address this issue, several alternative load patterns have been proposed for the seismic design of non-linear structures. However, due to the simplifications involved in the development of these design load patterns, their adequacy needs to be assessed for different structural systems and earthquake excitations before they can be used in common practice. The aim of this work was to identify the most suitable lateral load patterns for the seismic design of steel moment-resisting frames. To do this, the non-linear seismic behaviour of three-, five-, seven-, ten- and 15-storey frames designed with nine different lateral load patterns were compared under 20 real and synthetic spectrum-compatible earthquakes using performance parameters such as maximum inter-storey drift, maximum plastic hinge rotation and cumulative damage. It was found that, for the same structural weight, structures designed with more efficient load patterns experienced up to 68% less global damage than their code-based counterparts

Translation, cultural adaptation and assessment of psychometrics properties of the Extended Version of the Nordic Musculoskeletal Questionnaire (NMQ-E) in Persian language speaking people.

To translate and cross-culturally adapt the Extended Version of the Nordic Musculoskeletal Questionnaire (NMQ-E) into Persian (NMQ-E-P) and evaluate the psychometric properties in a general population with different occupational tasks across nine body regions. This cross-sectional study was designed according to the standard guidelines and the COSMIN checklist. The NMQ-E-P was achieved through forward and backward translation methods and consensus to produce the final draft. A Persian-speaking population (n = 571, age 38.24 ± 7.65 years, female = 46.2%) was recruited from industries and office workers with three occupational task inclusion criteria: assembly, office, and lifting. Psychometric properties included validity for face (from confirmed clarity, simplicity, and readability), content (via the content validity index); and construct (through known group validity); additionally, the properties of internal consistency (Cronbach's α); and test-retest reliability (Kappa coefficient of agreement) were considered. No significant issues during the translation process were found. The NMQ-E-P showed adequate internal consistency for all regions (α ≥ 0.87). The test-retest reliability was examined with Kappa agreement correlation coefficient and all items, except ankle regions, showed very good agreements (Kappa coefficient = 0.87-1.0). Excellent ICC values were obtained for quantitative variables (ICC &gt; 0.88) and good construct validity was revealed (p &lt; 0.001). The Persian version of the NMQ-E has very good validity and reliability and can be used by researchers and professionals to evaluate the prevalence of MSDs in nine body regions simultaneously