An Assessment of the Fire Safety Standards in Iranian Homes and Equipment As They Relate to Fire Accidents

Fire accidents and burns are one of the leading causes of death and disability worldwide. This study was conducted with the aim of studying the etiology of fire accidents as well as investigating the fire safety standards of both homes and equipment in Iran. Samples included patients with flame burns who consented to answer the questions. Questions covered five areas: patient demographics, epidemiological characteristics of burns, the fire safety status of the home, the fire safety status of the equipment, and the mechanism of the accident. In this study, the mean extent of the burns was 18.07 ± 14.29% of body surface area and was significantly related to the age grouping of the patients. The highest total body surface area (TBSA) was observed in patients between 19 to 39 years. The most common cause of flame injuries was gas explosions (36.81%). The interviews revealed that most of the houses were not equipped with smoke detectors or fire extinguishers. The extent of burns was significantly higher in patients living in unequipped homes (P = 0.047). Cooking equipment was often involved in the accidents (38.1%). Considering the low home fire safety and the role of equipment misuse and damaged equipment use in the occurrence of accidents, it seems that installing fire alarms and firefighting equipment, proper training on how to work with and maintain the equipment, using cooking and heating equipment correctly along with discontinuing use if damaged would all be effective and are highly suggestive to reduce fire injuries.

Air quality and health co-benefits of vehicle electrification and emission controls in the most populated United States urban hubs: Insights from New York, Los Angeles, Chicago, and Houston

Transitioning to electric vehicles (EVs) is a prominent strategy for reducing greenhouse gas emissions. However, given the complexity of atmospheric chemistry, the nuanced implications on air quality are yet to be fully understood. Our study delved into changes in PM2.5, ozone, and their associated precursors in major US urban areas, considering various electrification and mitigation scenarios. In the full electrification (FullE) scenario, PM2.5 reduction peaked at values between 0.34 and 2.29 μg.m-3 across distinct regions. Yet, certain areas in eastern Los Angeles exhibited a surprising uptick in PM2.5, reaching as much as 0.67 μg.m-3. This phenomenon was linked to a surge in secondary organic aerosols (SOAs), resulting from shifting NOx/VOCs (volatile organic compounds) dynamics and a spike in hydroxyl radical (OH) concentrations. The FullE scenario ushered in marked reductions in both NOx and maximum daily average 8-h (MDA8) ozone concentrations, with maximum levels ranging from 14.00 to 32.34 ppb and 2.58-9.58 ppb, respectively. However, certain instances revealed growths in MDA8 ozone concentrations, underscoring the intricacies of air quality management. From a health perspective, in the FullE scenario, New York, Chicago, and Houston stand to potentially avert 796, 328, and 157 premature deaths/month, respectively. Los Angeles could prevent 104 premature deaths/month in the HighE-BL scenario, representing a 29 % EV share for light-duty vehicles. However, the FullE scenario led to a rise in mortality in Los Angeles due to increased PM2.5 and MDA8 ozone levels. Economically, the FullE scenario projects health benefits amounting to 51-249 million $/day for New York, Chicago, and Houston. In contrast, Los Angeles may face economic downturns of up to 18 million $/day. In conclusion, while EV integration has the potential to improve urban air quality, offering substantial health and economic advantages, challenges persist. Our results emphasize the pivotal role of VOCs management, providing policymakers with insights for adaptable and efficient measures.

Constraining East Asia ammonia emissions through satellite observations and iterative Finite Difference Mass Balance (iFDMB) and investigating its impact on inorganic fine particulate matter

Uncertainty in ammonia (NH3) emissions causes the inaccuracy of fine particulate matter simulations, which is associated with human health. To address this uncertainty, in this work, we employ the iterative finite difference mass balance (iFDMB) technique to revise NH3 emissions over East Asia using the Cross-track Infrared Sounder (CRIS) satellite for July, August, and September 2019. Compared to the emissions, the revised NH3 emissions show an increase in China, particularly in the North China Plain (NCP) region, corresponding to agricultural land use in July, August, and September and a decrease in South Korea in September. The enhancement in NH3 emissions resulted in a remarkable increase in concentrations of NH3 by 5 ppb. in July and September, there is an increase in ammonium (NH4+) and nitrate (NO3-) concentrations by 5 μg/m3, particularly in the NCP region, while in August, both NH4+ and NO3- concentrations exhibit a decrease. For sulfate (SO42-), in August and September, the concentrations decreased over most regions of China and Taiwan, as a result of the production of ammonium sulfate; increased concentrations of SO42-, however, were simulated over South Korea, Japan, and the southern region of Chengdu, caused by higher relative humidity (RH). In contrast, during the month of July, our simulations showed an increase in SO42- concentrations over most regions of China. To gain a more comprehensive understanding, we defined a sulfur conversion ratio ( [Formula: see text] ), which explains how changes in sulfur in the gas phase affect changes in sulfate concentrations. A subsequent sensitivity analysis performed in this study indicated the same relationship between changes in ammonia and its effect on inorganic fine particulate matter (PM2.5). This study highlights the challenge of controlling and managing inorganic PM2.5 and indicates that reducing the emissions of air pollutants do not necessarily lead to a reduction in their concentrations.

Embryo selection through artificial intelligence versus embryologists: a systematic review

STUDY QUESTION

What is the present performance of artificial intelligence (AI) decision support during embryo selection compared to the standard embryo selection by embryologists?

SUMMARY ANSWER

AI consistently outperformed the clinical teams in all the studies focused on embryo morphology and clinical outcome prediction during embryo selection assessment.

WHAT IS KNOWN ALREADY

The ART success rate is ∼30%, with a worrying trend of increasing female age correlating with considerably worse results. As such, there have been ongoing efforts to address this low success rate through the development of new technologies. With the advent of AI, there is potential for machine learning to be applied in such a manner that areas limited by human subjectivity, such as embryo selection, can be enhanced through increased objectivity. Given the potential of AI to improve IVF success rates, it remains crucial to review the performance between AI and embryologists during embryo selection.

STUDY DESIGN SIZE DURATION

The search was done across PubMed, EMBASE, Ovid Medline, and IEEE Xplore from 1 June 2005 up to and including 7 January 2022. Included articles were also restricted to those written in English. Search terms utilized across all databases for the study were: ('Artificial intelligence' OR 'Machine Learning' OR 'Deep learning' OR 'Neural network') AND ('IVF' OR 'in vitro fertili*' OR 'assisted reproductive techn*' OR 'embryo'), where the character '*' refers the search engine to include any auto completion of the search term.

PARTICIPANTS/MATERIALS SETTING METHODS

A literature search was conducted for literature relating to AI applications to IVF. Primary outcomes of interest were accuracy, sensitivity, and specificity of the embryo morphology grade assessments and the likelihood of clinical outcomes, such as clinical pregnancy after IVF treatments. Risk of bias was assessed using the Modified Down and Black Checklist.

MAIN RESULTS AND THE ROLE OF CHANCE

Twenty articles were included in this review. There was no specific embryo assessment day across the studies-Day 1 until Day 5/6 of embryo development was investigated. The types of input for training AI algorithms were images and time-lapse (10/20), clinical information (6/20), and both images and clinical information (4/20). Each AI model demonstrated promise when compared to an embryologist's visual assessment. On average, the models predicted the likelihood of successful clinical pregnancy with greater accuracy than clinical embryologists, signifying greater reliability when compared to human prediction. The AI models performed at a median accuracy of 75.5% (range 59-94%) on predicting embryo morphology grade. The correct prediction (Ground Truth) was defined through the use of embryo images according to post embryologists' assessment following local respective guidelines. Using blind test datasets, the embryologists' accuracy prediction was 65.4% (range 47-75%) with the same ground truth provided by the original local respective assessment. Similarly, AI models had a median accuracy of 77.8% (range 68-90%) in predicting clinical pregnancy through the use of patient clinical treatment information compared to 64% (range 58-76%) when performed by embryologists. When both images/time-lapse and clinical information inputs were combined, the median accuracy by the AI models was higher at 81.5% (range 67-98%), while clinical embryologists had a median accuracy of 51% (range 43-59%).

LIMITATIONS REASONS FOR CAUTION

The findings of this review are based on studies that have not been prospectively evaluated in a clinical setting. Additionally, a fair comparison of all the studies were deemed unfeasible owing to the heterogeneity of the studies, development of the AI models, database employed and the study design and quality.

WIDER IMPLICATIONS OF THE FINDINGS

AI provides considerable promise to the IVF field and embryo selection. However, there needs to be a shift in developers' perception of the clinical outcome from successful implantation towards ongoing pregnancy or live birth. Additionally, existing models focus on locally generated databases and many lack external validation.

STUDY FUNDING/COMPETING INTERESTS

This study was funded by Monash Data Future Institute. All authors have no conflicts of interest to declare.

REGISTRATION NUMBER

CRD42021256333.

Epidemiology and Etiology of Burns in Iran Through the Examination of the Economic, Social and Educational Situation

Burn accidents continue to cause severe physical, psychological and economic damage to individuals and communities, especially in low- and middle-income countries. The present study was designed and conducted to investigate the epidemiology and identify the causes/mechanisms of burns in Iran, focusing on the economic, social and educational status of patients. This is a survey study that was performed from August 2016 to October 2017 on patients referred to Shahid Motahari University Hospital in Tehran. Samples included all patients whose parents or children were able to answer the questions. The data was extracted and analysed with SPSS Statistics v. 21. A total 1708 patients participated. Most of the patients were 19 to 39 years old. 70.6% had achieved a high school diploma or lower, and 11.5% patients were illiterate. Most of the patients lived in urban areas (91.7%) and in most cases, 4 people or less lived in a common space. Heat burns, chemical (acid) burns, and electrical burns account for the majority of cases. Most patients were unfamiliar with safety standards for burn prevention, safely stopping a fire, and fire safety equipment (alarms and extinguishers). The most common burn mechanisms were hot liquids inside the kitchen (12.6%) and gas explosion (11.9%). Based on these findings, the implementation of codified training programs, continuous control and monitoring of the safety standards in home and work environments, and the establishment of laws to standardize cooking and heating equipment will play an important role in reducing burn injuries in our country.

Prevalence of Thrombocytopenia in the First Week After Burn Injury and Its Relationship With Burn Severity in Shahid Motahari Hospital Over a Period of 6 Months in 2017

A platelet count of less than 150,000 per microliter of blood is called thrombocytopenia. Platelet count monitoring is essential in the care of burn patients. The aim of this study was to evaluate platelet count in groups of patients with different percentage of burns on the body surface and its relationship with the severity of burns and mortality. This retrospective descriptive cross-sectional study was performed on patients admitted to Shahid Motahari Hospital over a period of six months. The study was conducted on burn patients who were admitted to the hospital on the first day after injury. Patients were divided into two groups of with or without thrombocytopenia in the first week. Demographic information and treatment information about the patients were recorded. SPSS V.26 software was used for the statistical analysis of data. In this study, the prevalence of thrombocytopenia in the first week after burns was 36%. The variables of age, sex, duration of hospitalization, burn agent, percentage of burns and use of silver sulfadiazine ointment were significantly different in the two groups of patients. The group without thrombocytopenia had a mortality rate of 5.1%, while the group with thrombocytopenia had a rate of 32.2%. Based on the results of this study, thrombocytopenia is significantly associated with mortality in burn patients. Furthermore, the results of this study indicate that age, sex, burn agent, percentage of burns, and the use of silver sulfadiazine ointment have a clear impact on the thrombocytopenic status of patients.

Effect of combined use of cerebral oximetry and electroencephalogram monitoring on the incidence of perioperative neurocognitive disorders in adult cardiac and non-cardiac surgery: A systematic review of randomized and non-randomized trials

Background: There is insufficient evidence to recommend using either intraoperative cerebral oximetry or (processed) electroencephalogram (EEG) alone for preventing perioperative neurocognitive disorders (PNDs). Objective: To evaluate the effectiveness of combined use of cerebral oximetry and electroencephalogram-guided anesthesia on the incidence of PNDs in adult patients undergoing cardiac and non-cardiac interventions. Methods: A PICOS - based systematic review of English articles using Pubmed and Embase (from inception to August 2022) was performed. There were no exclusion criteria regarding the type of the study. Abstract proceedings and new study protocols or ongoing studies were not included. Review articles were analyzed in search of eligible references. All possible terms that were illustrative of PNDs were used. Results: Among the 63 full manuscripts that were analyzed in detail, 15 met the inclusion criteria. We found 2 retrospective, 8 prospective observational and 5 randomized controlled trials of which 1 did not evaluate the use of neuromonitoring in the randomization process. The definition and the methods used to diagnose PNDs were very heterogeneous. Only 8 studies used an algorithm to avoid/treat cerebral oxygen desaturation and/or to treat EEG abnormalities. Overall, there was a tendency towards less PNDs in studies where such an algorithm was used. Conclusions: Our results suggest that integrating information obtained from cerebral oximetry and an EEG monitor may reduce the incidence of PNDs whenever an adapted algorithm is used to improve brain function.

Investigation Of Common Burn Mechanisms, And Training And Safety Conditions In The Workplace

Workplace burn injuries are associated with significant physical, psychological, and social challenges. This study was designed and conducted to investigate the common burn mechanisms, and training and safety conditions in the workplace. The study is a cross-sectional study that was performed on patients admitted to Shahid Motahari University Hospital in Tehran from August 2016 to October 2017. Samples consisted of patients who suffered burns at work and were able to answer research questions. Data were recorded in tablets by electronic patient registration forms.Of the total burn patients under study, 14.28% were injured in the workplace. The burns were mainly thermal, followed by electrical, chemical, and inhalation burns. 38.2% of patients were not trained for safety measures at work and 27.8% of patients were not given personal protective equipment. 39.0% of workspaces were not safe against the risk of burns. Failure of devices and equipment was the cause of 28.8% of the accidents. Electrical damage, the ignition of flammable materials, gas explosions and contact with molten materials were the most common mechanisms in the occurrence of workplace burns. The lack of awareness by workers, lack of attention to the use of safety equipment at work, and the presence of damaged equipment are the main causes of burn accidents in the workplace. Therefore, the implementation of codified safety training and monitoring the observance of safety measures by workers and employers are recommended.

Changes in the ozone chemical regime over the contiguous United States inferred by the inversion of NOx and VOC emissions using satellite observation

To investigate changes in the ozone (O₃) chemical production regime over the contiguous United States (CONUS) with accurate knowledge of concentrations of its precursors, we applied an inverse modeling technique with Ozone Monitoring Instrument (OMI) tropospheric nitrogen dioxide (NO₂) and total formaldehyde (HCHO) retrieval products in the summers of 2011, 2014, and 2017, years in which United States National Emission Inventory were based. The inclusion of dynamic chemical lateral boundary conditions and lightning-induced nitric oxide emissions significantly account for the contribution of background sources in the free troposphere. Satellite-constrained nitrogen oxide (NO_x) and non-methane volatile organic compounds (NMVOCs) emissions mitigate the discrepancy between satellite and modeled columns: the inversion suggested 2.33-2.84 (1.07-1.34) times higher NO_x over the CONUS (over urban regions) and 0.28-0.81 times fewer NMVOCs emissions over the southeastern United States. The model-derived HCHO/NO₂ column ratio shows gradual spatial changes in the O₃ production regime near urban cores relative to previously defined threshold values representing NO_x and VOC sensitive conditions. We also found apparent shifts from the NO_x-saturated regime to the transition regime (or the transition regime to the NO_x-limited regime) over the major cities in the western United States. In contrast, rural areas, especially in the east-southeastern United States, exhibit a decreased HCHO/NO₂ column ratio by -1.30 ± 1.71 with a reduction in HCHO column primarily driven by meteorology, becoming sensitive to VOC emissions. Results show that incorporating satellite observations into numerical modeling could help policymakers implement appropriate emission control policies for O₃ pollution.

Verification of two alternative do-it-yourself equipment respirator seal as COVID-19 protection (VADERS-CoV) : a quality assessment pilot study

Background : During the COVID-19 pandemic, healthcare workers were facing shortage in personal protective equipment, especially adequate respirators. Alternative do-it-yourself respirators emerged, without any proof of protection. Objective : Verify seal potential of two alternative respirators compared to a common FFP2 respirator. Design : Quality assessment pilot study. Setting : Tertiary Care Hospital. Participants : Ten anaesthesiology residents. Interventions : Participants performed quantitative face-fit tests (QNFT) with three respirators to evaluate seal. A common FFP2 “duckbill” respirator was used as baseline (control group). Alternatives tested in this study were an anaesthesia face mask and a full-face modified snorkelling mask with a 3D-printed connector, both in conjunction with a breathing system filter. Main outcome : Non-inferior seal performance of the alternatives over FFP2, assessed by calculated QNFT based on measured individual fit factors, as defined by the Occupational Safety and Health Administration. Results :For each respirator a total of 90 individual fit factor measurements were taken. Within the control group, seal failed in 37 (41%) measurements but only in 10 (11%) within the anaesthesia mask group and in 6 (7%) within the snorkelling mask group (P < 0.001 respectively). However, when calculating the final, mean QNFT results, no difference was found between respirators. Successful QNFT were determined for 5 out of 10 participants in the FFP2 group, for 8 in the anaesthesia mask group (P = 0.25) and for 7 in the snorkelling mask group (P = 0.69). Conclusion : Both do-it-yourself respirators successfully pass QNFT and have the potential to provide non inferior seal compared to a common FFP2 respirator. While anaesthesia masks are easily assembled, snorkelling masks must undergo significant but feasible modifications. Our results suggest that those do-it-yourself respirators seem to be viable alternatives for situations when certified respirators are not available but need further investigation for validation. Trial registration: Clinicaltrials.gov identifier: NCT04375774 Key Points : Question: Can alternative do-it-yourself respirators protect wearers from hazardous aerosols? Findings : Our findings demonstrate that do-it-yourself respirators have the potential to provide non-inferior seal as compared to regular FFP2 personal protective equipment. Meaning : Our real-life situational testing provides evidence that do-it-yourself respirators potentially provide sufficient seal to compete with or even outperform conventional FFP2 respirators and that face-fit testing should be a mandatory safety check in healthcare providers.

The effects of stress-coping strategies and group cognitive-behavioral therapy on nurse burnout

The purpose of this study was to determine the effects of teaching stress-coping strategies and group cognitive-behavioral therapy on stress and burnout among nurses. Stress and burnout have always been a significant problem in nursing, which can have a direct or indirect negative impact on the individual and his/her social life. A semi-experimental study was conducted on 60 nurses by means of a pre-test and post-test design. Nurses meeting the inclusion criteria were assigned to two groups, a control group and an intervention group, by the block randomization method. The nurses in the intervention group received group cognitive-behavioral therapy. They completed the Maslach Burnout Inventory (MBI) before, immediately after and one month post intervention. There was a significant negative correlation only between burnout and work experience (r = -0.35 and p = 0.01). After intervention, burnout (p = 0.002) significantly decreased. The effectiveness of the intervention was also maintained after a month. The results showed that stress-coping strategies and group cognitive-behavioral therapy can be effective in reducing burnout. This method can be used to provide counseling services for nurses in health centres.

Effectiveness of incorporating occupational therapy in rehabilitation of hand burn patients

One of the main goals in the rehabilitation process of patients with burn to their hands is their return to society and their professional occupation, which has a direct positive influence on these patients' quality of life. The goal of this research project was to investigate the effect of early intervention with occupational therapy in patients with burns to their hands. The study included 30 patients with second or third degree hand burns. Patients were added to the study 12 days after their burn wounds and grafted areas had healed. They had 3 sessions of occupational therapy per week for 8 weeks. These sessions included active and passive range of motion exercises, active resistive exercises, stretching exercises and practicing activities of daily living. Functionality of the hand was assessed before and after the 8 weeks of occupational therapy using the DASH questionnaire. The average initial DASH score before intervention with occupational therapy was 60.9, and after 8 weeks of occupational therapy it was 33.9 (average difference between the pre-intervention and post-intervention DASH scores is 27 points, p < 0.001). After 8 weeks of occupational therapy, patients performed activities of daily living with a lot less difficulty, and an increase in functionality of the hands was observed. This study suggests that early intervention with rehabilitative therapies is advantageous and may result in improved hand function.

Diabetes and foot burns

The incidence of diabetes and diabetic foot burns is increasing worldwide. In the present study, we surveyed frequency, morbidity and mortality of diabetic foot burn patients in our centre. The study was a cross-sectional survey with one-year follow up of our adult diabetic patients with lower extremity burns. Data on demographics, cause of burn, time from injury to hospital, TBSA, presence of neuropathy and diabetic foot, treatment plan for controlling blood sugar, smoking, infection, morbidity, co-morbid diseases, amputation and mortality were gathered from patient files. Statistical analysis was done with SPSS 21 software. A p value less than 0.05 was considered significant. Of the 34,300 burn patients seen in a year, 2096 were admitted according to ABA criteria. 47 patients had diabetic foot burn. Half of them had diabetic neuropathy. 48.9% had type I diabetes and 51.1% had type II. 70.2% were male, 29.8% were female. Mean +/- SD age was 58 +/- 14 years; 14 patients were smokers and 40 had co-morbid diseases. Hypertension frequency was 44%, ischemic heart disease 25%, CVA 8.5% and renal failure 6.4%. Half of the patients had uncontrolled blood sugar. Mean +/- SD delay in admission was 2.5±1.5 (days). Mean +/- SD TBSA was 2.4 +/- 1.4%. Mean +/- SD length of stay was 11.4±6.1 (days). 8.5% underwent amputation and there were no deaths. Diabetic foot burn patients delay seeking medical attention, have a longer length of stay, more complications and more amputations than other burn patients (compared with our previous study on burn patients). Prevention and training programs are highly needed to prevent foot burns.

Comparing the effect of colactive plus ag dressing versus nitrofurazone and vaseline gauze dressing in the treatment of second-degree burns

Wound care quality and speed of burn healing are important factors that affect the treatment, prognosis and complications of burns. Burn care is challenging, and the ideal method controversial. The aim of this study was to compare the effects of a new dressing (ColActive dressing) in the treatment of superficial second-degree burns versus traditional dressing including Vaseline and Nitrofurazone. This was a randomized clinical trial study involving 25 cases. A superficial second-degree burn area was divided into two parts in each patient; randomly, traditional dressing was used on one area, and ColActive plus Ag dressing on the other. Every 3 days, after removing the dressings and washing the wounds, wound surface area was evaluated by medical photographic records and J image software. Wound surface area in the two groups was compared before dressing and on the 3rd, 6th, 9th and 12th day afterwards. The difference was not significant before dressing, but significant on the 3rd, 6th, 9th and 12th post-operative day. The difference was significant in both groups, but it was more prominent in the ColActive group (p<0.001) than in the traditional group (p<0.05). Considering the results of this study and good results in previous case reports, ColActive may be more effective than traditional dressing. We suggest a more comprehensive study for a longer period with a larger number of cases to compare other important variables such as scar quality, cost, and pain in the two dressings.

Introduction to a case of orf disease in a burn wound at Motahari Hospital

Orf disease is caused by a double-stranded DNA virus of the Parapox family. Human infection is mostly due to occupational hazard and handling infected animals. Our patient was an 18-year-old woman who suffered burns in 2015. Total Burn Surface Area (TBSA) was 22% and cause of burn was flame. One week after hospital admission, she underwent skin grafts of her upper extremities. However, vegetative granulomatous ulcerations developed on the wound, resulting in the grafts failing to take. After careful investigation into the patient's history, we discovered that the water used to douse the flames was from a drinking trough for sheep. Suspecting Orf disease, we disinfected the wounds and dressing tools with Dakin's solution. We waited about 12 days to perform a new skin graft, and most of the grafted skin took. PCR test for Parapox virus was positive. Orf disease should be considered a distinct possibility in burn patients with a history of probable contamination. Manipulation of the disease in the early stages of burn wound could potentially spread it and change the degree of the wound, therefore being aware of this possibility can save the patient unnecessary pain and time. To prevent a nosocomial outbreak of Orf, wound care and wound disinfection should be scrupulously carried out. Isolation and disinfection of the entire dressing tool should be considered. Educating wound care providers in burn hospitals and scrupulous wound disinfection would protect the patient from cross contamination and allow skin grafts to take with ease, without the formation of ulcerations associated with Orf.

Treatment of third-degree burn wounds in animal specimens: acellular dermis or partial-thickness skin graft

Several dermal products have been introduced to substitute dermal tissues. In this study we review the effects of these products on repairing third-degree burn wounds and managing complications in animal specimens. Using an interventional approach, rats were randomly assigned to four groups (G1 to G4). Two wounds were created on the back of each rat. An open wound was left on the back of rats in G1; in G2, wounds were covered with a thick rat derived-ADM product and overlying thin skin graft; on G3 rats, similar third degree ulcers were made with one ulcer covered with harvested thin skin graft. In G4, ulcers were covered with a thin rat derived-ADM product and thin graft. Factors such as take rate, histopathological score, wound contracture and graft contracture were compared on the 7th, 15th, 21st and 30th day. Mean graft take rate on the 30th day in the thick ADM, thin ADM and graft group showed a significant difference (p=0.015). Histopathological score on the 30th day in the thin ADM, thick ADM and graft group showed no considerable difference. Mean graft take rate was significantly better in the thin ADM and graft group than in the thick ADM group. Wound contracture was significantly more severe in the thick ADM and control group than in the thin ADM and graft group.

Analysis of the effect of subcutaneous injection of omental-derived cells on the healing of third degree burns in rats: a preliminary study

Burn injury is considered a global health issue. Third degree burn wounds do not heal spontaneously and require skin grafts. Some factors could contribute to wound healing. In this study we assessed the effect of non-fatty omental cells in burn wound healing. Similar third degree burn wounds were induced on the back of 192 rats. Forty-eight of these rats were put in a control group that did not receive any treatment. The rest of the rats were put in 3 groups, each receiving a different treatment regime. Rats in group 2 had a daily application of silver sulfadiazine; group 3 rats were injected with omental cells, and group 4 rats were injected with phosphate buffer saline (PBS) once, followed by daily application of Vaseline to the burned region. Parameters such as open epidermis length, number of epidermal cell layers, granulation tissue thickness (GTT) and neutrophil density were evaluated in each group. The average open epidermis length in the omental cell group was less than in the other groups on days 10 and 20 (P<0.05). The thickness of epidermal cell layers in the group receiving cells was greater than in the other groups on all days. On the 20th day, there was a significant difference in GTT between the four groups (P<0.05). The injection of non-fatty omental cells has a positive effect on third degree burn wounds in rats.

Investigating the relationship between microalbuminuria and prognosis of patients with severe burns in the Motahari Burn Hospital

Microalbuminuria seems to be a reflection of increased vascular permeability caused by systemic inflammatory response, and is likely to be a predictor of mortality, sepsis and other outcomes of severe burn patients. We investigated the impact of microalbuminuria on the prognosis of patients with severe burns. This is a prospective study on severe burn patients (above 20%) admitted in the first 24 hours after burns to the Motahari Burn Hospital. Patients' microalbuminuria was measured at admission and 48 hours later, and its relationship with patient prognosis (sepsis, renal failure, death, inhalation injury and systemic inflammatory response syndrome) was analyzed. We concluded that microalbuminuria at admission in patients with severe burns was directly related to inhalation injury (P = 0.018), ARDS during hospitalization (P = 0.001) and length of hospital stay (P = 0.025). Moreover, microalbuminuria at 48 hours after admission had a direct connection with patient death (P = 0.001), sepsis (P = 0.001), renal failure (P = 0.001) and SIRS (P = 0.001). Microalbuminuria is a simple, noninvasive, fast and affordable test to predict sepsis, mortality, renal failure, systemic inflammatory response and a finding associated with inhalation injury in severe burn patients, making it a fast prognostic predictor that helps to improve the management of these patients.

LA50 in burn injuries

Burn injuries put a huge financial burden on patients and healthcare systems. They are the 8th leading cause of mortality and the 13th most common cause of morbidity in our country. We used data from our Burn Registry Program to evaluate risk factors for mortality and lethal area fifty percent (LA50) in all burn patients admitted over two years. We used multiple logistic regressions to identify risk factors for mortality. LA50 is a reliable aggregate index for hospital care quality and a good measure for comparing results, also with those of other countries. 28,690 burn patients sought medical attention in the Emergency Department, and 1721 of them were admitted. Male to female ratio was 1,75:1. 514 patients were under 15 years old. Median age was 25 (range: 3 months - 93 years). Overall, probability of death was 8.4%. LA50 was 62.31% (CI 95%: 56.57-70.02) for patients aged 15 and over and 72.52% (CI 95%: 61.01-100) for those under 15. In the final model, we found that Adjusted OR was significant for age, female sex, TBSA and inhalation injury (P < 0.05). LA50 values showed that children tolerate more extensive burns. Female sex, burn size, age and inhalation injury were the main risk factors for death. Authorities should pay special attention to these variables, especially in prevention programs, to reduce mortality and improve patient outcome. Children have better outcome than adults given equal burn size. Suicide rates are higher for women than men in our country.

Intraoperative cerebral hypoperfusion and electroencephalogram suppression resulting in neurological complications after cardiac surgery : the need for an in depth investigation

Reports on the demographic profile of older populations estimate that, in 2050, 19 countries will have at least 10% of their population aged 80 years or more. Many high risk elderly patients undergo cardiac surgery. In addition, advanced age has been shown to be a strong predictor of adverse neurological outcome. Despite sig- nificant improvements achieved in the perioperative care of cardiac surgical patients, neurological complications remain a global health issue. Recent findings have pointed out that cerebral hypoperfusion and too deep levels of anesthesia are major sources of adverse neurological outcomes. Cerebral near-in-frared spectroscopy provides information about cerebral perfusion non-invasively, and is increasingly used. Depth of anesthesia is evaluated using monitors that are based on processed electroencephalogram. This non-systematic review focuses on the results of studies performed with each monitor separately, and the need for a combined evaluation of their utility and eventual impact on neurological outcomes. The use of a combined cerebral monitoring strategy based on the two aforementioned monitors is proposed in order to optimize cerebral outcomes.

Financial burden of burn injuries in iran: a report from the burn registry program

Understanding the cost of burn treatment is very important for patients, their families, governmental authorities and insurance companies. It alleviates patient and familial stress, provides a framework for better use of resources, and facilitates better performance between burn centers. Hospital burn costs can provide a basis for authorities to budget for acute burn treatment, for further management of chronic complications, and for planning prevention and public educational programs in Iran. To identify costs we used data from our burn registry program. Over the two-year assessment period, we treated roughly 28,700 burn patients, 1,721 of whom were admitted, with a mortality rate of 5.9%. The male to female ratio was 1.7:1 (63% male; 37% female). Flame burns were most frequent (49.8%) followed by scalds (35.7%). Mean hospital stay was 14.41 days (range 0-64 days). Mean TBSA was 17.39%. Skin grafts were carried out in 65.4% of the patients, with a mean of 5.2 surgeries per patient. The total cost of all patient admissions over the two years was US$ 4,835,000. The maximum treatment cost for one patient was US$ 91,000. The mean cost per patient was US$ 2,810 (29,500,000 Rials). The mean cost for each percent of burn was US$ 162. The mean cost for a one-day stay in hospital was US$ 195. The mean cost of each operation was US$ 540. Patients who contracted infections endured longer hospital stays, meaning increased costs of US$ 195 per day. With comparable outcome and results, the cost of burn treatment in Iran is cheaper than in the US and Europe.

A mechanistic model for oxide growth and dissolution during corrosion of Cr-containing alloys

We have developed a corrosion model that can predict metal oxide growth and dissolution rates as a function of time for a range of solution conditions. Our model considers electrochemical reactions at the metal/oxide and oxide/solution interfaces, and the metal cation flux from the metal to the solution phase through a growing oxide layer, and formulates the key processes using classical chemical reaction rate or flux equations. The model imposes mass and charge balance and hence, is labeled as the Mass Charge Balance (MCB) model. Mass and charge balance dictate that at any given time the oxidation (or metal cation) flux must be equal to the sum of the oxide growth flux and the dissolution flux. For each redox reaction leading to the formation of a specific oxide, the metal oxidation flux is formulated using a modified Butler–Volmer equation with an oxide-thickness-dependent effective overpotential. The oxide growth and dissolution fluxes have a first-order dependence on the metal cation flux. The rate constant for oxide formation also follows an Arrhenius dependence on the potential drop across the oxide layer and hence decreases exponentially with oxide thickness. This model is able to predict the time-dependent potentiostatic corrosion behaviour of both pure iron, and Co–Cr and Fe–Ni–Cr alloys.

Epidemiology of outpatient burns in Iran: an update

Burn injury remains a serious and devastating issue faced by developing countries. It is also true, however, that the developed world still tackles many of the challenges caused by burns. In order to reduce this problem through preventive programs, the characteristics of this type of injury must be studied and well documented in each setting. Our study aims to show the epidemiology, demographic distribution and clinical outcomes of burns patients referred to Motahari Burn Hospital, the burn care center that receives the most referrals in Iran. This cross-sectional study, from March 2009 to March 2010, included 6,910 patients with burn injuries who were managed as outpatients. The patient demographics along with the characteristics of the burn injuries and their outcomes were recorded for each case and then evaluated. A total of 6,910 burn patients with a mean ± SD age of 30.20 ± 19.11 years presented to our Emergency Department and were treated as outpatients. Of these, 2,900 were female (41.97%) and 4,010 were male (58.03%). Most of the patients were in the 25-35 year age group, with a prevalence of 1,148 (28.6% of total) males and 716 females (24.7% of total), followed by those aged <15-years-old. Most patients had been burned accidentally. An increase in the instance of self-immolation was identified with an increase in the TBSA burned. Mean follow-up was 30+/-5 months. The results revealed that burns were most likely to occur during housekeeping. Other high risk groups identified were males, those aged from 25 to 35 years-old, and those with lower socio-economic status.

The burn registry program in Iran - First report

Burn injury is still a major problem in Iran, resulting in many reports which are usually dispersed, uncoordinated and probably unreliable. We created a burn registry comprised of a data entry program with 222 variables for each admitted burn patient. This program was established in August 2010 at the Iran University of Medical Sciences, Motahari Burn Hospital. We had 14,277 burn patients from August 2010 to August 2011, 877 of whom were admitted to the hospital. Of the patients, 65.9% were male and 34.1% were female. The age was 28.85 years (SD = 19.77). The most prevalent cause of burn was flame 78.5% (pipe propane gas 57.2; kerosene 19.9%). The mean total body surface area (TBSA) involvement was 23%. A total of 77.8% of patients were discharged with partial recovery, while mortality was 8.9%. The mean hospital stay was 14.63 days (SD =11.07). The program is designed to help understand the scope of burn injury in Iran, providing information on patients, etiology, and course of treatment. It also highlights differences between various parts of the country in terms of the causes and frequency of burn injuries. Moreover, the burn registry provides a basis for further research and surveys for treatment and preventive programs. Our results showed that, although Emergency Medical Services (EMS) staff are highly capable and well-trained, their coverage seems to be less than 50% and needs to be increased. Marriage status was shown to have no influence on the occurrence of burns, and among our patients, 57.0 % were poorly educated.

The management of dental waste in dental offices and clinics in Shiraz, Southern Iran

BACKGROUND

Dental waste can be hazardous to humans and the environment.

OBJECTIVE

To determine the current status of dental waste management in private and public dental clinics and private dental offices in Shiraz, southern Iran.

METHODS

This cross-sectional study was conducted at the Shiraz University of Medical Sciences from February through June 2013. A stratified random sampling method was used to study 86 private offices, 14 private clinics and 10 public clinics. Types of waste studied included mercury and amalgam, lead foil packets, sharps, infectious tissues and fluids, pharmaceuticals and domestic waste materials. Compliance with established standards by the monitored dental offices and clinics and public clinics were compared.

RESULTS

89.1% of dental offices and clinics disposed their infectious waste with domestic waste. Only 60% of centers used standard method for sharps disposal. None of the dental centers disposed their pharmaceutical waste and x-ray fixer waste by standard methods. Less than 10% of centers recycled the amalgam and lead foil pockets waste to the manufacture.

CONCLUSION

Government agencies should establish monitoring programs for all dental offices and clinics to identify noncompliant activity and enforce recommended regulations.

Massive postoperative pulmonary embolism in a young woman using oral contraceptives: the value of a preoperative anesthetic consult

We describe the case of a woman with a history of active tabagism and on the oral contraceptive Yasmin, presenting in the Post-Anesthesia Care Unit (PACU) with a cardiac arrest due to massive pulmonary embolism following transforaminal lumbar interbody fusion surgery. The patient had preoperatively several risk factors for deep venous thrombosis. This case-report emphasizes the value of a preoperative anesthetic visit and eventual temporary cessation of certain oral contraceptives in specific cases.

How do nurses manage their occupational exposure to cytotoxic drugs? A descriptive survey in chemotherapy settings, Shiraz, Iran

Occupational exposure to cytotoxic drugs is a global concern. We conducted this cross-sectional study in 2012 to describe the adverse effects experienced by nurses working in one of chemotherapy facilities affiliated to Shiraz University of Medical Sciences, Shiraz, southern Iran, and their proper use of personal protective equipment and educational programs. The frequency of side effects reported by participants was noticeably high. Approximately, 60% of the nurses used all personal protective equipment. There were air conditioner ventilation systems in all facilities, but they were not standard. Clinics did not have any dedicated room. Lack of adequate training was noticeable among all participants. We concluded that establishment of safety regulations, health care workers safety surveillance systems as well as continuous training for nurses are of paramount importance.

Effect of thyroid dysfunctions on blood cell count and red blood cell indice

BACKGROUND

Thyroid hormones have a crucial role in metabolism and proliferation of blood cells. Thyroid dysfunction induces different effects on blood cells such as anemia, erythrocytosis leukopenia, thrombocytopenia, and in rare cases causes' pancytopenia. It also alter RBC indices include MCV, MCH, MCHC and RDW. Thus this study attempted to evaluate effect of hypo & hyperthyroidism on blood cell count and RBC indices.

MATERIALS AND METHODS

This study performed on 102 patients with hypothyroid (14.1 years), 84 with hyperthyroid (15.6 years) and 118 healthy individuals (15.2 years) as control group. Initially patients TSH level of patients was determined by ELISA method, and then according to TSH ranges (0.3-5.5µIU/mL) patients were divided into two Hyperthyroidism (TSH<0.3µIU/mL) and hypothyroidism (TSH>5.5µIU/mL) groups. Then, complete blood count was measured by cell counter. Finally, obtained results were analyzed by SPSS software.

RESULTS

Analyzes of obtained data revealed statistically significant difference between two groups of patients in RBC count, MCH, MCHC, RDW, HB and HCT(P-value<0.05), but the difference was not significant for WBC and PLT counts and MCV (P-value>0.05).

CONCLUSION

In case of patients with unknown hematological dysfunctions, must be evaluated for thyroid hormones.

Human split-thickness skin allograft: skin substitute in the treatment of burn

BACKGROUND

Human skin allograft has been used as wound coverage for a long time; it is one of the most successful and widely used dressings for burn wounds in the world.

OBJECTIVE

To prepare a freeze-dried human split-thickness skin allograft and evaluate its cytotoxicity, the structure and physical properties after processing methods and clinical efficacy in burn patients.

METHODS

After ensuring tissue safety, we lyophilized human cadaveric partial thickness skin and exposed it to gamma radiation. Histopathological and immunohistochemical properties, tensile strength and in vitro cytotoxicity were assayed for the skin samples. Then, we tested the samples in 11 patients with deep skin burn.

RESULTS

On histological and histopathological examinations, we found a normal skin structure. The tensile strength of the rehydrated freeze-dried human skin allograft was not lesser than the fresh human skin. Cell viability in MTT testing was more than 95%. None of our patients showed any signs of immunological reactions or complications.

CONCLUSION

Gamma-irradiated freeze-dried human split-thickness skin is safe and non-toxic and can be used for the treatment of patients with deep skin burn.

Ethnobotanical study of medicinal plants used by Kurd tribe in Dehloran and Abdanan Districts, Ilam Province, Iran

This paper provides significant ethnobotanical information on pharmaceutical plant uses, where some degree of acculturation exists, so that there is urgency in recording such data. The aim of this work is to catalogue, document, and make known the uses of plants for folk medicine in Dehloran and Abdanan districts, Ilam Province, Iran. An analysis was made of the species used, parts of the plant employed, preparation methods, administration means, and the ailments treated in relation to pathological groups. A folk botanical survey was carried out from February 2007 to October 2009. The information was collected from 81 persons (60% men and 40% women) in 20 villages. The informants reported data on 122 species, belonging to 49 botanical families, were claimed as medicinal. This work is focused on human medicinal plant uses, which represent 95% of the pharmaceutical uses. The most commonly represented families were Asteraceae (37.5%), Lamiaceae (20.8%), Rosaceae (18.7%), Fabaceae (16.7%) and Apiaceae (14.6%). Some of the uses were found to be new when compared with published literature on ethnomedicine of Iran. The folk knowledge about medicinal plant use is still alive in the studied region, and a number of scarcely reported plant uses has been detected, some of them with promising phytotherapeutical applications. The results of the study reveal that some of species play an important role in primary healthcare system of these tribal communities.

Prevalence of hepatitis A virus in sea food in Iran

The objective of this study was to determine the prevalence of Hepatitis A Virus (HAV) in sea food samples in the Isfahan and Shahrekord townships in Iran. From September 2010 to April 2011, a total of 300 samples of fresh fish, shrimp, crab and lobster were obtained from randomly selected retail stores in the Isfahan and Shahrekord townships in Iran. The samples were tested for the presence of HAV using a reverse transcriptase- polymerase chain reaction method. Out of the total number of samples examined, 8 (2.7%) were found to be positive for HAV. This virus was detected in 5% and 1.7% of fresh fish and shrimp, respectively. This study shows the importance of sea food as potential sources of HAV infection in people in Iran.

Precautions for health care workers to avoid hepatitis B and C virus infection

The burden of exposure to blood-borne pathogens (such as hepatitis B and C viruses) is considerable for health care workers. Hepatitis virus transmission requires a non-immune host, an infectious source, and skin or mucous membrane injury. These three aspects are the main fields for preventional interventions. We reviewed major recent studies on this topic to identify precautions health care workers should take to avoid hepatitis B (HBV) and C virus (HCV) infections. Accordingly, this review looks at aspects of epidemiology, risk factors, economy, knowledge, attitudes, practice, and ethics of HBV and HCV that affect health care workers. The risk of transmission depends on the load of pathogen, infectious characteristics and exposure frequency. Health care workers skill levels and the specific hospital department involved appear to be the most important factors in the exposure of health care workers to blood-borne pathogens. However, many health care workers surveyed, believed that educational programs about standard precautions in their setting were not adequate. Obviously, more detailed studies will be needed to clarify risks and opportunities for health care workers precautions aimed at avoiding HBV and HCV infection, especially in emerging health research communities.

Skull segmentation in 3D neonatal MRI using hybrid Hopfield Neural Network

A fully automated method for segmentation of neonatal skull in Magnetic Resonance (MR) images for source localization of electrical/magnetic encephalography (EEG/MEG) signals is proposed. Finding the source of these signals shows the origin of an abnormality. We propose a hybrid algorithm in which a Bayesian classifying framework is combined with a Hopfield Neural Network (HNN) for neonatal skull segmentation. Due to the non-homogeneity of skull intensities in MR images, local statistical parameters are used for adaptive training of Hopfield neural network based on Bayesian classifier error. The experimental results, which are obtained on high resolution T1-weighted MR images of nine neonates with gestational ages between 39 and 42 weeks, show 65% accuracy which consistently exhibits our scheme's superiority in comparison with previous neonatal skull segmentation methods.

Abnormal sensations evoked over the chest and persistent peri-incisional chest pain after cardiac surgery

Risk factors for developing Persistent peri-incisional Chest Pain (PCP) after sternotomy are multiple. We examined whether hypoesthesia, hyperalgesia or dysesthesia, evoked in the postoperative period might be associated with PCP after sternotomy. One hundred patients undergoing a sternotomy were evaluated on day 5. Peri-incisional sensory testing was performed using von Frey filament. Presence and severity of PCP were assessed at 2 and 6 months. PCP was present in 29% and 15% of patients respectively at 2 and 6 months. Hyperalgesia on day 5 was present in 43% of patients with PCP at 6 months compared to 15% without PCP. Hypoesthesia was present in 57% of patients with PCP at 6 months compared to 22% without PCP. There was no significant difference in the incidence of dysesthesia. On day 5, hyperalgesia was correlated with a risk to develop PCP at 6 months. Among sensory abnormalities, the presence of hyperalgesia is associated with PCP at 6 months postoperatively.

Cystatin C in cardiac surgery

Cystatin C has recently been proposed as an alternative marker of glomerular filtration rate. The study compares cystatin C and creatinine concentrations during cardiopulmonary bypass and the first 72 hours postoperatively in patients undergoing coronary artery bypass graft. Forty-nine patients with normal preoperative renal and cardiac function were scheduled for coronary artery bypass graft. Blood was sampled for creatinine and cystatin C measurements at 7 time points till 72 hours postoperatively. Glomerular filtration rate was estimated from calculated clearance using the Cockroft and Gault formula for creatinine and Larsson equation for cystatin C. The baseline values of both markers were within the normal range. Their concentrations were comparable during the whole study period. This was also the case for the calculated creatinine and cystatin C clearance. In patients with normal preoperative renal function undergoing coronary artery bypass graft, measured creatinine concentration remains a cheap and easy way of estimating renal function.