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Objectives@#This study aimed to examine the effect of the coronavirus disease 2019 (COVID-19) outbreak on the hospitalization rate, emergency department (ED) visits, and outpatient clinic visits in western Iran. @*Methods@#We collected data on the monthly hospitalization rate, rate of patients referred to the ED, and rate of patients referred to outpatient clinics for a period of 40 months (23 months before and 17 months after the COVID-19 outbreak in Iran) from all 7 public hospitals in the city of Kermanshah. An interrupted time series analysis was conducted to examine the impact of COVID-19 on the outcome variables in this study. @*Results@#A statistically significant decrease of 38.11 hospitalizations per 10,000 population (95% confidence interval [CI], 24.93–51.29) was observed in the first month of the COVID-19 outbreak. The corresponding reductions in ED visits and outpatient visits per 10,000 population were 191.65 (95% CI, 166.63–216.66) and 168.57 (95% CI, 126.41–210.73), respectively. After the initial reduction, significant monthly increases in the hospitalization rate (an increase of 1.81 per 10,000 population), ED visits (an increase of 2.16 per 10,000 population), and outpatient clinic visits (an increase of 5.77 per 10,000 population) were observed during the COVID-19 pandemic. @*Conclusion@#Our study showed that the utilization of outpatient and inpatient services in hospitals and clinics significantly declined after the COVID-19 outbreak, and use of these services did not return to pre-outbreak levels as of June 2021.
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Multiple sclerosis (MS) is an inflammatory disease of central nervous system (CNS). The mmune system plays an important role in its pathogenesis. Current treatments are unable to cure patients and prevent the progression of MS lesions. Stem cell-based cell therapy has opened a new window for MS treatment. Stem cells regulate immune responses and improve axonal remyelination. Stem cells can be obtained from different origins such as embryonic, neural, bone marrow, and adipose tissues. But yet there is a challenge for the selection of the best cell source for stem cell therapy. Mesenchymal stem cells (MSCs) are a type of stem cell obtained from different origins and have significant immunomodulatory effects on the immune system. The increasing evidence have suggested that umbilical cord and adipose tissue can be a suitable source for isolation of MSCs. Moreover, human amniotic epithelial cells (hAECs) as novel stem cell origins by having immunoregulatory effects, regenerative effects, and less capacity of antigenicity can be a candidate for MS treatment. This review discussed the mechanistic effects of MSCs with a focus on human amniotic epithelial cells, which can be used to treatment and improvement of outcome in MS disease.
ABSTRACT
Multiple sclerosis (MS) is an inflammatory disease of central nervous system (CNS). The mmune system plays an important role in its pathogenesis. Current treatments are unable to cure patients and prevent the progression of MS lesions. Stem cell-based cell therapy has opened a new window for MS treatment. Stem cells regulate immune responses and improve axonal remyelination. Stem cells can be obtained from different origins such as embryonic, neural, bone marrow, and adipose tissues. But yet there is a challenge for the selection of the best cell source for stem cell therapy. Mesenchymal stem cells (MSCs) are a type of stem cell obtained from different origins and have significant immunomodulatory effects on the immune system. The increasing evidence have suggested that umbilical cord and adipose tissue can be a suitable source for isolation of MSCs. Moreover, human amniotic epithelial cells (hAECs) as novel stem cell origins by having immunoregulatory effects, regenerative effects, and less capacity of antigenicity can be a candidate for MS treatment. This review discussed the mechanistic effects of MSCs with a focus on human amniotic epithelial cells, which can be used to treatment and improvement of outcome in MS disease.
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Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization’s conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.
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Transcranial direct current stimulation (tDCS) is a promising method for altering cortical excitability with clinical implications. It has been increasingly used in neurodevelopmental disorders, especially attention-deficit hyperactivity disorder (ADHD), but its efficacy (based on effect size calculations), safety, and stimulation parameters have not been systematically examined. In this systematic review, we aimed to (1) explore the effectiveness of tDCS on the clinical symptoms and neuropsychological deficits of ADHD patients, (2) evaluate the safety of tDCS application, especially in children with ADHD, (3) model the electrical field intensity in the target regions based on the commonly-applied and effective versus less-effective protocols, and (4) discuss and propose advanced tDCS parameters. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach, a literature search identified 14 empirical experiments investigating tDCS effects in ADHD. Partial improving effects of tDCS on cognitive deficits (response inhibition, working memory, attention, and cognitive flexibility) or clinical symptoms (e.g., impulsivity and inattention) are reported in 10 studies. No serious adverse effects are reported in 747 sessions of tDCS. The left and right dorsolateral prefrontal cortex are the regions most often targeted, and anodal tDCS the protocol most often applied. An intensity of 2 mA induced stronger electrical fields than 1 mA in adults with ADHD and was associated with significant behavioral changes. In ADHD children, however, the electrical field induced by 1 mA, which is likely larger than the electrical field induced by 1 mA in adults due to the smaller head size of children, was sufficient to result in significant behavioral change. Overall, tDCS seems to be a promising method for improving ADHD deficits. However, the clinical utility of tDCS in ADHD cannot yet be concluded and requires further systematic investigation in larger sample sizes. Cortical regions involved in ADHD pathophysiology, stimulation parameters (e.g. intensity, duration, polarity, and electrode size), and types of symptom/deficit are potential determinants of tDCS efficacy in ADHD. Developmental aspects of tDCS in childhood ADHD should be considered as well.
ABSTRACT
Transcranial direct current stimulation (tDCS) is a promising method for altering cortical excitability with clinical implications. It has been increasingly used in neurodevelopmental disorders, especially attention-deficit hyperactivity disorder (ADHD), but its efficacy (based on effect size calculations), safety, and stimulation parameters have not been systematically examined. In this systematic review, we aimed to (1) explore the effectiveness of tDCS on the clinical symptoms and neuropsychological deficits of ADHD patients, (2) evaluate the safety of tDCS application, especially in children with ADHD, (3) model the electrical field intensity in the target regions based on the commonly-applied and effective versus less-effective protocols, and (4) discuss and propose advanced tDCS parameters. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach, a literature search identified 14 empirical experiments investigating tDCS effects in ADHD. Partial improving effects of tDCS on cognitive deficits (response inhibition, working memory, attention, and cognitive flexibility) or clinical symptoms (e.g., impulsivity and inattention) are reported in 10 studies. No serious adverse effects are reported in 747 sessions of tDCS. The left and right dorsolateral prefrontal cortex are the regions most often targeted, and anodal tDCS the protocol most often applied. An intensity of 2 mA induced stronger electrical fields than 1 mA in adults with ADHD and was associated with significant behavioral changes. In ADHD children, however, the electrical field induced by 1 mA, which is likely larger than the electrical field induced by 1 mA in adults due to the smaller head size of children, was sufficient to result in significant behavioral change. Overall, tDCS seems to be a promising method for improving ADHD deficits. However, the clinical utility of tDCS in ADHD cannot yet be concluded and requires further systematic investigation in larger sample sizes. Cortical regions involved in ADHD pathophysiology, stimulation parameters (e.g. intensity, duration, polarity, and electrode size), and types of symptom/deficit are potential determinants of tDCS efficacy in ADHD. Developmental aspects of tDCS in childhood ADHD should be considered as well.
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Objective: To compare the effect of three different fiber reinforcement strategies on the fracture strength of composite resin restored endodontically treated premolars. Material and Methods: Seventy-two sound human premolars extracted for orthodontic reasons were divided into 6 groups (n=12) after endodontic treatment. Group 1: intact teeth (positive control); Group 2: endodontically treated teeth without restoration (negative control); Group 3: composite resin restoration; Group 4: placement of fibers at occlusal position; Group 5: splinting the buccal and palatal walls with horizontal fiber posts; Group 6: placement of fibers at the occlusal position after splinting the buccal and palatal walls with horizontal fiber posts. Then fracture strength was measured at a crosshead speed of 0.5 mm/min in a universal testing machine. Data were analyzed using one-way ANOVA and post hoc Tukey tests at α=0.05. Results: There were significant differences between the negative and positive control groups (p<0.001) and between the negative control group and all the other study groups (p<0.001). However, there were no statistically significant differences between the positive control group and all the experimental groups and between the experimental groups (p>0.05). Conclusion: Fiber insertion had no additional reinforcing effect on the fracture strength following composite resin restoration.
Subject(s)
Tensile Strength , Bicuspid , Materials Testing , Composite Resins , Tooth, Nonvital , Analysis of Variance , IranABSTRACT
Background: Measuring patients' satisfaction shows the efficacy of care providers to meet patients' expectations and supplies the valuable data for health policy makers. This study was conducted to assess patients' satisfaction from hospital services and its relationship with responsiveness
Methods: This cross-sectional study was carried out at Zanjan University of Medical Sciences in 2013 -2014. A total of 486 were selected and World Health Survey [WHS] questionnaire data was used
Results: Most of the inpatients [76. 4 %] and more than half of outpatient [54.2 %] rated overall hospitals services at level of average and high satisfaction. The most favorable dimension in terms of patients' satisfaction was quality of care from both group patients point of view. There was statistically significant relationship between responsiveness domains and patients' satisfaction [p < 0.01]. The findings of this study showed that the majority of inpatients and half of outpatients were overall satisfied with hospitals services
Conclusion: Both inpatients and outpatients were satisfied with quality of delivered care, but there was low satisfaction from participation in decision- making for inpatients and access to services in outpatients
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Background: The performance of the HSE units has various dimensions Leading to different performances. Thus, any industry should be capable of evaluating these systems. The aim of this study was to design a standard questionnaire in the field of performance evaluation of HSE management system employing Balanced Score Card model
Methods: In this study we, first determined the criteria to be evaluated in the framework of Balanced Score Card model based on the objectives and strategies of HSE Management System and existing standards, and then designed questions on every criterion. We used content validity and Cronbach's Alpha to determine the reliability and validity of the questionnaire
Results: The primary questionnaire was comprised of 126 questions some of which were omitted regarding the results obtained from the CVR and CVI values. We obtained the CVI average of environmental dimension to be 0.75 and its CVI average 0.71
Conclusion: With respect to the results of the reliability and validity of this questionnaire,and its standardized design we can suggest using it for evaluation of HSE management system performance in organizations and industries with the mentioned system
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Background: Reproduction is an important population concept throughout the world, and demographists consider it among four main life events. Given Iran's population growth policy, this study was conducted to assess the tendency to pregnancy in women in Zanjan
Method: From among health centers in five geographical districts in Zanjan [North, South, East, West, and Center], one was randomly selected from each district, and the study was conducted on a total of 400 people. Data were analyzed in SPSS-16 using descriptive and inferential tests including Chi-square, t-test [mean test] and variance analysis
Results: A total of 186 women [46.5%] desired pregnancy after marriage and 212 [53%] did not. Also, 209 husbands [52.2%] agreed with childbearing after marriage, and 186 [45.5%] disagreed
Conclusion: Childbearing can be encouraged among husbands agreeing with pregnancy of their spouse [more than half] and women attending pregnancy counseling and family planning centers
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Canine visceral leishmaniasis [CVL] is a systemic disease with a high mortality rate, caused by a diphasic protozoan parasite, Leishmania infantum/chagasi in the world. The objective of the present study was to determine the presence of CVL in the city and suburbs of Kerman, using a range of serological, histopathological and molecular methods. Blood samples were taken from 80 clinically symptomatic stray dogs All the collected blood samples were tested by direct agglutination test [DAT] to detect the anti-Leishmania antibodies in dogs, using a cut-off value of >/= 1:320. Pathological specimens including spleen, liver and lymph nodes were prepared for paraffin blocks, sectioning, staining and final microscopic examination in the pathology laboratory. PCR amplification of kDNA from 9 samples of DAT positive stray dogs was studied. The anti-Leishmania antibody was detected in 9 dogs [11.25%] of the total 80 studied dogs. No significant difference was found between VL infection and gender. In contrast, there was a significant difference between seropositivity and age [P<0.05]. Pathological samples showed changes including hyperplasia of infected macrophages and inflammatory cells that occupied sinusoids and splenic cords. Among the samples which was characterized by PCR, only one specimen revealed to be mixed infection between L. infantum and L. tropica. The results revealed a high prevalence of L. infantum infection in stray dogs in Kerman. This kind of information is needed for implementation of future control programs
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Background: Disintegration and dewatering of produced sludge during wastewater treatment is one of the main challenges in wastewater treatment process. The aim of this study is to investigate the efficiency of ultrasonic method on dewatering of bio sludge in wastewater treatment plant under different conditions and select the best conditions.
Materials and Methods: In the present study, sludge disintegration and sludge dewatering after undergoing different conditions of frequency [35 and 130 KHz] and detention time [3, 5, 10 and 30 min] were investigated and finally the changes of SCOD, CST and SRF were determined.
Results: The results illustrated that the maximum ability of dewatering was obtained at a detention time of 5 min and frequency of 35 KHz for ultrasonic. Under this conditions SCOD%, CST and SRF were achieved to 4.3%, 151 S and 2.1×1013 m/kg respectively.
Conclusion: According to the results, ultrasonic method significantly increases the sludge disintegration and improves the sludge dewatering.
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Background and Aims: Epilepsy is a central nervous system disorder that appears as sudden convulsions, and transient, repetitive and unpredictable movment, with sensory-motor and autonomic sources. Nowadays, patients with epilepsy use various types of chemical drugs which turn out side effects and cause drug resistance in long-term use. Ease of using herbal plants and their public acceptance have provided them appropriate for pharmacological purposes. Scrophularia striata Boiss., plant grows in areas of Ilam in Iran, has been experimentally used in the treatment of various diseases. In this experiment, the effect of hydroalcoholic extract of this plant was studied on pentylenetetrazol-induced seizures
Methods: 40 male mice [25-30 g] were randomly selected and divided into five groups of 8, including a control group [receiving saline and pentylenetetrazol] and 4 treatment groups [receiving the extract doses of 150, 300, 600, 900 mg/kg]. 30 minutes after interaperitoneal administration of saline and extract, pentylenetetrazol [80 mg/kg] was injected. The mice were immediately transferred to a special cage and convulsive behaviors were recorded by a camera during the 20 minutes. Then, the different phases of seizure were evaluated
Results: Extract injection in dose of 150 mg/kg had no significant effect on onset time of different levels of seizure. But, extract injection in doses of 300 and 600 and 900 mg/kg delayed the onset time of tonic, clonic and tonic-clonic seizures. The extract administration in all treatment doses also reduced duration time of tonic and tonic-clonic seizures and decreased the numbers of imbalances and fallings in different seizure phases. As well, the extract decreased mortality to zero
Conclusion: Our study indicated that the hydro-alcoholic extract of Scrophularia striata Boiss. has an appropriate anticonvulsant effect and it seems that the future studies are necessary to separate its ingredients and understand its mechanism of action
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Pain management is very important in tonsillectomy in order to reduce the suffering and restlessness in children. The aim of this study was to investigate the effect of peritonsillar injection of lidocaine and placebo preoperatively on postoperative pain relief. This randomized triple blind clinical trial conducted on sixty 3-12-year-old children who were candidate for tonsillectomy. Children were randomly assigned to lidocaine and placebo groups. Anesthesia inducted similarly for all patients and peritonsillary 1 mg/kg lidocaine [per 2 ml volume] in the first group and 2 ml normal saline in the second group was injected. Pain assessment was performed using the self-report Oucher Scale and CHEOPS. The mean pain score in lidocaine group in 5, 15, 30, 60,120 and 240 minutes after surgery was lower than placebo group but this difference [in Oucher scale] was only statistically significant at 240 minuets after surgery [P =0.03]. The preoperative peritonsillar injection of lidocaine is an effective method of reducing post-tonsillectomy pain in children
Subject(s)
Humans , Female , Male , Lidocaine , Lidocaine/administration & dosage , Tonsillectomy , Child , Pain, Postoperative/prevention & controlABSTRACT
Despite the widespread prevalence of canine parvovirus disease [CPV] in Iranian dog population, molecular diagnosis of CPV variants, and investigation of the trends of its genetic changes is a new effort. In this study 50 samples from dogs suspicious of infection with clinical signs of diarrhea and vomiting, and 25 samples from dogs suspected of infection with general symptoms such as depression and anorexia were collected from dogs presented to the veterinary clinic of Shiraz University, Shiraz, Iran. Viral DNA was extracted from feces. Three specific pairs of primers, P2, Pab, and Pb, were used in a PCR assay for differential diagnosis of the virus type. Pab primer pairs detect the new type-strains, CPV-2a and 2b. The primer pairs P2 and Pb detect CPV types 2 and 2b, respectively. Our results showed that 44 individuals with clinical signs of diarrhea and vomiting were positive for CPV-2. 39 individuals [89%] were positive for CPV-2b and 5 individuals [11%] for CPV-2a. Therefore, the CPV-2b was identified as the predominant virus type. All dogs without symptoms of diarrhea and vomiting were CPV-negative. The relationship of breed, age and sex with PCR results was not significant [P>0.05]. For the first time in the country, the causative agent of CPV-2 was identified, and presence of new antigenic variants, CPV-2a and CPV-2b was confirmed
Subject(s)
Animals , Polymerase Chain Reaction , DNA, Viral , Dogs/virologyABSTRACT
Schizophrenia and various neurological disorders have some signs and symptoms. Visual hallucinations are one of such disorders. The related studies in some diseases for example Parkinson Disease and Lewy Body Dementia indicate that Acetylcholine [Ach] plays a significant role in neuropsychiatric manifestation and its association with visual hallucination; therefore, visual hallucinations occur due to the depletion of Ach. Drug therapies such as Cholinesterase inhibitors [ChEls] for increasing Ach level may be beneficial in treating visual hallucination. AchEI's have been used in the treatment of visual hallucinations in Dementia and Parkinson's Disease. We thought that a similar Ach depletion may cause visual hallucinations in patients with schizophrenia and may provide a target for drug treatment. We had a patient with schizophrenia whose psychotic symptoms responded to the treatment plan, but her visual hallucination did not. However, the patient's visual hallucination successfully responded to Rivastigmine [AchEl]. This case illustrates the use of an AchEl in the treatment of refractory visual hallucinations in a patient with schizophrenia
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Gender identity disorder and paraphilia and related therapies are of debatable issues in psychiatry. The authors introduce some of the disorders which to be cured via behaviorial techniques. In all of patients the diagnosis was compatible with DSMIV criterion. Therapeutic method considered for them was cognitive behaviord regardless of any type of comorbidities. The mentioned therapeutic technique resulted in considerable improvement signs [except for one case] in these patients. Positive effects of CBT in almost all of these patients mean that morbiological treatment could be considered as an effective therapeutic approach. Although good compliance in patients was not ignorable for successful results, considering CBT in any patients should be a role before nonreversible treatments such as surgery or stigmatizing patients as treatment resistant case