Electroconvulsive therapy in single manic episodes: a case series

Objective: To evaluate the effectiveness of electroconvulsive therapy in the treatment of Bipolar I Disorder patients with a single manic episode. Method: In a retrospective study, we reviewed medical records of inpatients who had been admitted to treat a single manic episode of Bipolar I Disorder at Noor University Hospital, Isfahan, Iran between September 2004 and December 2008. Results: Out of a total of 275 single episode manic patients, 39 underwent ECT. Male/ female ratios were 19/20 (48.7% vs. 51.3%) for the ECT series and 137/99 (58% vs. 42%) for the exclusive pharmacological treatment series (p>0.05). Mean age of patients in the ECT series (23.64 ± 8.00) was significantly lower than the pharmacological treatment series (27.65± 11.30, p= 0.008). The mean length of stay (LOSs) for the ECT series (20.0± 7.90) was significantly higher than the other group (14.63± 9.84, p =0.001). The mean time to first administered ECT (tECT) was 4.35 ± 3.79. There was no significant difference between the mean LOSs of the pharmacologic treatment series and the mean “LOSs minus tECT“(LOS-tECT) variable (16.57±8.43) in the ECT series (p>0.05). The mean duration from the onset of the symptoms to time of admission was 19.22± 3.53 for the ECT series. Catatonia was the indication for application of ECT in one patient (2.6%), while 25 (64.10%) received ECT because of aggressive behavior. The proportion of patients administered chemical and physical restraints before ECT (77%) significantly dropped (7.7%) after ECT administration (

Seasonal Variation in Exposure Level of Types A and B Ultraviolet Radiation: An Environmental Skin Carcinogen

Background: The main source of ultraviolet radiation (UVR) is the sun, affecting organs such as the skin, eyes, and immune system. According to American Conference of Governmental Industrial Hygienist (ACGIH) reports, the amount of UVR reaching the Earth’s surface is increasing yearly and is responsible for an increase in solar radiation‑related diseases. Aims: To investigate the amount of UVR reaching the Earth’s surface and understand the risk of UVR on disease among outdoor laborers in one of the central provinces of Iran.Materials and Methods: Arak city was divided into two geographic areas, and the weekly measurement of UVR was done in three locations) asphalt, grass and rooftop). To measure UVR, Hanger UV spectrometer, standard deviation (SD8‑A), and SD8‑B detectors were used. Amounts of UVR for a consecutive year and varying weather conditions were measured. Finally, values obtained were compared to ACGIH standards. Results: The minimum and maximum levels of UV type A radiation occurred in April 1.27 (0.724) W/m2 and September 7.147 (4.128) W/m2, these figures for UV type B were in March–April 0.005 (0.003) and September 0.083 (0.077). The maximum UVR is received between 11 and 15 o’clock.Conclusions: In the central cities of Iran, the minimum and maximum UV type A and B is received in March–April and in September, respectively. Based on the results, the angular position of the sun in the sky, cloud cover, and height from ground level affected the amount of UVR received, but the geographic locations studied did not.  Keywords: Outdoor Job, Skin Cancer, Carcinogen, Ultraviolet radiation, Ultraviolet A, Ultraviolet B, Ira

Knowledge management in the field of risk management in a corporate environment, Iran’s oil industry

Organizations in almost every industry and country are reminded, all too frequently, that they operate in a risky world.In this scientific paper, the extent of employees’ training effects on financial and human resource risks is investigated. For this purpose, one of the well-known courses - Geometric Dimensioning and Tolerancing (GD&T) in the gas processing company Fajr Jam was studied and its return on investments (ROI) was measured to determine the key indicators and the actual effectiveness of them that can also affect the risk. All GD&T training courses are considered as integrated and modular. In addition, since calculating the qualitative effects of each training course and converting it into financial impacts is one of the most complex and even impossible parts of ROI, quantitative effects were first calculated in order to identify the least visible effect of training on financial results. Thereby, it is possible to prove that, at least, these courses have a positive impact on the overall productivity of the organization. Then the qualitative effects, that are always the most important and influential role of training were defined.In this research, interviews with experts in this field were used to determine the key indicators that are the basis for calculation ROI and to receive information. At first stage all aspects of the study were considered and then the assessment form of training ROI was compiled according to indicators. The results of this study we reahed, using a paired questionnaire that examines all the various factors in the achievements, which are evaluated to determine the effect of training in this process by the Analytic Hierarchy Process (AHP) method and Expert Choice software. In this research, all GD&T courses were studied for a year and a half. Finally, ROI was 829 %. This circumstance shows that the economic investments in this training course were reasonable and within 5 years, the organization returned 8.29 times of its investments

Effects of Selenium Supplementation on Gene Expression Levels of Inflammatory Cytokines and Vascular Endothelial Growth Factor in Patients with Gestational Diabetes

Selenium is known to exert multiple beneficial effects including anti-inflammatory actions. The aim of the study was to evaluate the effects of selenium supplementation on gene expression levels of inflammatory cytokines and vascular endothelial growth factor (VEGF) in women with gestational diabetes (GDM). This randomized double-blind, placebo-controlled trial was carried out among 40 subjects diagnosed with GDM aged 18–40 years old. Subjects were randomly allocated into two groups to receive either 200 μg/day selenium supplements (n = 20) or placebo (n = 20) for 6 weeks. Gene expression of inflammatory cytokines and VEGF were assessed in lymphocytes of GDM women with RT-PCR method. Results of RT-PCR indicated that after the 6-week intervention, compared with the placebo, selenium supplementation downregulated gene expression of tumor necrosis factor alpha (TNF-α) (P = 0.02) and transforming growth factor beta (TGF-β) (P = 0.01), and upregulated gene expression of VEGF (P = 0.03) in lymphocytes of patients with GDM. There was no statistically significant change following supplementation with selenium on gene expression of interleukin (IL)-1β and IL-8 in lymphocytes of subjects with GDM. Selenium supplementation for 6 weeks in women with GDM significantly decreased gene expression of TNF-α and TGF-β, and significantly increased gene expression of VEGF, but did not affect gene expression of IL-1β and IL-8

Pregnancy and renal transplantation

Context: The current study aimed at providing an evidence-based and up-to-date review of the literature regarding the assessment and outcomes of pregnancy in patients with renal transplant. Design: It was a review of the current literature. Conclusions: According to the current study findings, the function or survival of renal allograft was not adversely affected by getting pregnant. Therefore, ideal care for these patients needs a multidisciplinary approach including maternal-fetal medicine, nephrology, and neonatology specialists. © 2018, Nephro-Urology Monthly

Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stenting for large and multiple biliary stones: Will it improve the outcomes?

Background: The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones. Methods: Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group. Results: A total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05). Conclusion: Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval. Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines. © 2020, The Author(s)

Prevalence and antimicrobial susceptibility pattern of toxigenic clostridium difficistrains isolated in iran

Background/aim: Clostridium difficile is a frequent cause of nosocomial infections and has become a major public health concern in developed nations. In the present study, the prevalence and antimicrobial susceptibility pattern of toxigenic C. difficile strains isolated in Iran were investigated. Materials and methods: Between June 2016 and May 2017, 2947 inpatient fecal samples were taken from symptomatic adult hospitalized patients in different units of 32 care facilities in Tehran, Iran. C. difficile strains were identified by microbiological/biochemical methods. Susceptibility to 20 antimicrobials was measured by E-test method. Toxin-specific immunoassays and cytotoxicity assays were used to determine in vitro toxin production. Results: Out of 2947 fecal samples, 538 (18.25) C. difficile isolates were obtained among those with suspected CDI. In E-test method, all C. difficile isolates were susceptible to fidaxomicin, vancomycin, amoxicillin/clavulanate, and meropenem and were resistant to penicillin G. The prevalence of multidrug resistant C. difficile was 69.33 (373/538). Among 538 C. difficile, 147 (27.32), 169 (31.41), and 222 (41.26) isolates were TcdA+/TcdB+, TcdA-/TcdB+, and TcdA-/TcdB-, respectively. Conclusion: The results evidently support the hypothesis of a probable role of toxigenic strains of C. difficile in developing gastrointestinal complaints in patients with diarrhea. © TUBİTAK

Estimation of the wastage rate of MMR and pentavalent vaccines in open and closed vials in three western provinces of Iran

Background: Vaccine wastage is one of quality indicators of immunization program and high vaccine wastage will increase overall costs and impede efforts towards a more efficient and sustainable program. We aimed at estimating of the wastage rates of Measles-Mumps-Rubella (MMR) and pentavalent (diphtheria-tetanus-pertussis-hepatitis B -Haemophilus influenza type b) vaccines in different vaccine vial sizes. Study design: Multicentre descriptive study using existing data. Methods: This study was in three provinces (Hamadan, Kermanshah and Kordestan) of Iran including 131,135 populations with 2,548 under-1years children. Twenty-seven health facilities were selected randomly from nine districts in three provinces of western part of Iran. Six-months data including vaccination and vaccine stock records collected from April to September 2017. Finally, number of opened vials and number of target population vaccinated were collected and data were analysed to estimate the wastage rates in both unopened and opened vials of both antigens. Results: The wastage rate for combined MMR 2-dose and 5-dose opened vials for three provinces was 29%(Hamadan 18%, Kermanshah 14% and Kordestan 52%). The wastage rate for combined pentavalent single-dose and 10-dose vials for three provinces was 17% (in Kordestan33%, 11% Kermanshah 11% and Hamedan 3%). The total average of pentavalent single-dose and 10-dose vials wastage rate was 5% and varied 13% for urban and 3% for rural areas. The average of discarded unopened vials wastage rate in all facilities for MMR was 3.9% (3.2% for MMR 2-dose vial and 10.2% for MMR 5-dose vial). This rate was 1.7% for pentavalent total (1.9% for single dose vial and 0.4% for 10 dose vial). Conclusion: The vaccine wastage rates in Iran are in line with other countries and lower than the suggested rate based on WHO policies for multi-dose vials. The wastage rates were different for in provinces, districts and health facilities. The MMR total wastage rate in rural is higher than those in urban areas. However, the pentavalent total wastage rate was higher in urban area

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10-14 and 50-54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings The global TFR decreased from 2.72 (95% uncertainty interval [UI] 2.66-2.79) in 2000 to 2.31 (2.17-2.46) in 2019. Global annual livebirths increased from 134.5 million (131.5-137.8) in 2000 to a peak of 139.6 million (133.0-146.9) in 2016. Global livebirths then declined to 135.3 million (127.2-144.1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2.1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27.1% (95% UI 26.4-27.8) of global livebirths. Global life expectancy at birth increased from 67.2 years (95% UI 66.8-67.6) in 2000 to 73.5 years (72.8-74.3) in 2019. The total number of deaths increased from 50.7 million (49.5-51.9) in 2000 to 56.5 million (53.7-59.2) in 2019. Under-5 deaths declined from 9.6 million (9.1-10.3) in 2000 to 5.0 million (4.3-6.0) in 2019. Global population increased by 25.7%, from 6.2 billion (6.0-6.3) in 2000 to 7.7 billion (7.5-8.0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58.6 years (56.1-60.8) in 2000 to 63.5 years (60.8-66.1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.Peer reviewe