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In the study area, groundwater is the main water resource for various purposes such as drinking, agriculture and industrial. To evaluate the hydrochemical characteristics of groundwater and suitability for drinking, irrigation and industrial purposes, seventy-seven samples were collected and analyzed for various ions. Results show that, groundwater in the study area is mainly hard to very hard, and slightly alkaline-fresh to brackish in nature. According to the hydrochemistry diagrams, the main groundwater types are Ca, Mg-HCO, Na-HCO and Na-Cl. Calculation of mineral saturation index indicate that the groundwater samples are saturated with respect to carbonate minerals and under-saturated with respect to sulfate minerals such as gypsum and anhydride. The mineral weathering, mixing, ion exchange and anthropogenic activity are the dominant hydrogeochemical natural processes. Results of investigating the quality of heavy metals and calculating the heavy metal index indicated that the groundwater of study area is not contaminated with heavy metals. In this research, the various indices were used to determine the quality of groundwater for various uses. Calculate the indices and comparison results with the WHO standards to determine the quality of groundwater for various uses indicated that the most of the groundwater in study area is chemically suitable for drinking, industrial and agricultural uses. [ABSTRACT FROM AUTHOR]

Southwestern Iran's Golgir plain lies on chalky bedrock made up of Tertiary gypsum surrounded and covered by thin Quaternary deposits. Since the onset of the new millennium, this region and its farmland has been prone to land depression and other instability phenomena linked to gypsum dissolution. A simple water balance over the period of 2005 to 2012 was employed to assess the role of sinkholes in these phenomena. Geological and geophysical features as well as initial water balance calculations confirmed the presence of sinkholes and their influence in the study area. A significant discrepancy (2.55x106 m³) was observed between annual estimates of water inputs and discharge from the region, likely attributable to errors in identifying and quantifying output components. A bedrock map derived from geophysical investigations and the geological characterization of the chalky bedrock showed that, in comparison to the local groundwater table, there was a roughly 40 m drawdown towards the location of sinkholes. Groundwater inflow towards the aquifer was revised so as to include an identified sinkhole output component in the water balance equation, resulting in a much greater accuracy in the annual water balance estimates. Estimated annual recharge volumes ranged from 4.39x106 to 7.15x106 m³, with a mean of 5.64x106 m³. The water balance equation was shown to constitute a simple, cost-effective, and reliable approach to the recognition and evaluation of sinkholes in areas under similar conditions. [ABSTRACT FROM AUTHOR]

The river and groundwater are significant components of hydrological cycle, and the interaction between these two water resources attracted a great attention recently. Over the years, several methods have been used for the study of the water exchanges between these resources. In this research, a combined approach including hydraulic head measurements, hydrochemistry, and water balance calculations is applied to the assessment of the river-aquifer interactions. The study area is located in the north part of the Dezful-Andimeshk district in the southwest of Iran. The Dez River is the major surface water body that interacts with groundwater in this area. The Dez dam has been constructed on this river in the northern part of the study area. In this study, a series of water measurements including river water stages and discharge monitoring at Dez dam site and Dezful hydrometric station, groundwater table measurement in the piezometric network, and chemical analysis of river and groundwater were carried out for the evaluation of river-aquifer interaction. In order to monitor river and groundwater in the study area, a monitoring network including a hydrometric station (near the Dezful city), 38 piezometers, and 23 water quality monitoring wells have been established by the Khuzestan Water and Power Authority (KWPA). Data of the monitoring network were used for the evaluation of temporal variation of river and groundwater interaction in this research. The discharge measurements of the Dez dam site and Dezful hydrometric station in a 47-year period (1964-2011) shows that the water volume is decreased between these two stations. In addition, examining the time series of river stage and groundwater fluctuations in the study area shows that the groundwater table and river water stage variations have similar patterns. This similar pattern is an observant indication of groundwater and surface water interactions that is confirmed by the interpretation of groundwater potentiometric map of the study area. Following these conclusions, the hydrochemical measurements also were used for the assessment of the Dez River and groundwater connectivity. The surveys showed the similar patterns in the temporal variation trends of chemical characteristics (especially chloride ion) of the Dez River and groundwater as a base for connectivity of these resources. For better assessment of the river-aquifer interaction, 69 groundwater samples were collected from the abstraction wells in August 2012. The physicochemical analysis results show the river influences the groundwater quality. That is, the amounts of electrical conductivity (EC), temperature, and anions such as chloride, sulfate, and nitrate show a notable decrease in river-adjacent wells. Finally, for the quantifying of river-aquifer exchange rate, a simple water balance was formulated. This water budget also confirmed the Dez River role in the hydrologic balance of the study area, and according to calculation, the water infiltration from the riverbed was estimated to be more than 8 % of the aquifer recharge. This research shows the losing nature of the Dez River and its influence on the underlying groundwater quality in the study area. [ABSTRACT FROM AUTHOR]

Background and the purpose of the Study: Extract of Boswellia Serrata species has been used in the Indian traditional medicine in the treatment of various inflammatory diseases. The present study was designed to evaluate anti-inflammatory effects of Frankincense in the treatment of gingivitis, which is a periodontal tissue inflammatory disease. Methods: This double blind randomized placebo controlled trial was carried out among high school female students with moderate plaque-induced gingivitis. Based on either administration of 0.1 gram of Frankincense extract or 0.2 gram of its powder or placebo and whether the patients undergone scaling and root planning (SRP) or not, they were randomly assigned to 6 groups. The primary efficacy outcome was changes in Gingival Index (Loe & Sillness) and the secondary outcomes were alteration in plaque index (Sillness & Loe), bleeding index (Cowell) and probing pocket depth (WHO probe). All indices were measured in the 0, 7th and 14th days of the study. Results: Seventy five patients ranged of 15-18 years old were enrolled. At the end of the study, the indices in all groups showed significant decreases in comparison to the first day {p< 0.05), except for the bleeding index in the group without SRP and drug therapy (p-0.111). More precise analysis of data revealed that SRP in association with Frankincense application (either extract or powder) can lead to remarkable decrease in inflammatory indices in comparison to the groups without SRP and drug therapy (p<0.001). In addition, no significant difference was observed between powder or extract therapy (p >0.05) and between patients received either SRP or treatment alone (p=0.169). Conclusion: Frankincense, a safe and low-cost herbal medicine, may be feasibly applied to improve inflammation based disease of gingival as an adjunct to the conventional mechanical therapy. [ABSTRACT FROM AUTHOR]

Introduction: Due to the importance of prolonged mechanical ventilation (PMV) as a postoperative complication, predicting "high-risk" patients by identifying predisposing risk factors is of important issue. The present study was aimed to identify perioperative variables associated with PMV in patients undergoing open heart surgery.Methods: A total of 743 consecutive patients, American Society of Anesthesiologists (ASA)physical status class III, who were scheduled to undergo open heart surgery using cardiopulmonary bypass were included in this observational study. Perioperative variables were compared between the patients with and without PMV, as defined by an extubation time of >48 h.Results: PMV occurred in 45 (6.1%) patients. On univariate analysis, pre-operative variables;including gender, history of chronic obstructive pulmonary disease (COPD); chronic kidney disease and endocarditis, intra-operative variables; including type of surgery, operation time,pump time, transfusion in operating room and postoperative variables; including bleeding andinotrope-dependency were significantly different between patients with and without PMV (all P

BACKGROUND Incidental findings of renal infarct secondary to thrombosis in acutely ill patients present a unique challenge in diagnosis. We present a case of idiopathic renal infarct to highlight its workup and management and encourage further investigation of renal infarctions. CASE REPORT A 68-year-old woman with a past medical history of diet-controlled diabetes, hypertension, and hyperlipidemia presented to the Emergency Department (ED) for abdominal pain. She was found to be in diabetic ketoacidosis with pyelonephritis, so she was admitted to the Intensive Care Unit (ICU) for insulin and dextrose drip. Due to her abdominal pain, she underwent computed tomography (CT) of her abdomen and pelvis with contrast. This revealed multifocal infarcts of her right kidney with noncalcified thrombus at the proximal right renal artery. Subsequent CT angiography confirmed a right renal artery thrombus. She was started on subcutaneous enoxaparin and downgraded to basic level of care. Her history was negative for prior thrombosis, hypercoagulable state, and abdominal trauma. Echocardiogram and limited hypercoagulable workup were largely unremarkable. A multidisciplinary team evaluated the patient and recommended no surgical intervention. Following downgrade from the ICU, the patient was transitioned from enoxaparin to apixaban. She was discharged with plans for anticoagulation for 6 months, aspirin daily, and repeat CT angiogram abdomen/pelvis in 1 month. CONCLUSIONS This case illustrates the difficulties in elucidating the cause of incidental renal thrombosis in an acutely ill patient. Diagnostic workup is limited in the inpatient setting, but therapeutic anticoagulation remains the standard of treatment regardless of etiology.

Congenital cleft lip and palate represent the prevailing craniofacial birth anomalies on a global scale. Notably, a substantial proportion of patients within remote regions of Iran defer corrective surgery until later stages of life, often in childhood or adulthood, primarily due to intricate financial and cultural constraints. In response to this pressing healthcare challenge, a dedicated collective of volunteer plastic surgeons was established in 2009 with the explicit aim of providing medical care to these underserved patients. Over the subsequent years, this compassionate team embarked on 31 meticulously planned missions to underprivileged areas scattered across the country. Through these organized endeavors, a remarkable total of 20,579 medical visits were conducted, coupled with the performance of 2,303 essential surgeries, thus offering a lifeline of healthcare to these disadvantaged individuals., Competing Interests: None declared.

Immune checkpoint inhibitors (ICIs), a significant breakthrough treatment of cancer, exert their function through enhancing the immune system's ability to recognize and attack cancer cells. However, these revolutionary cancer treatments have been associated with a range of immune-related adverse effects, including cardiovascular toxicity. The most commonly reported cardiovascular toxicities associated with ICIs are myocarditis, pericarditis, arrhythmias, and vasculitis. These cardiovascular manifestations are often severe and can lead to life-threatening complications. Therefore, prompt identification and management of these toxicities is critical, and a multidisciplinary teamwork by cardiologists and oncologists are required to ensure optimal patient outcomes. In this review, we summarize the current knowledge on the mechanisms underlying ICI-associated cardiovascular toxicity, clinical presentations of these toxicities, potential risk factors, diagnosis, management, and surveillance strategies during ICI therapy. While ICIs have already transformed cancer treatment, further research is needed to better understand and manage their immune-related cardiovascular effects, and possibly, to identify biomarkers which can predict the occurrence of these cardiovascular complications., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Excessive exploitation of groundwater resources can increase the concentration of pollutants in addition to the progressive drawdown of groundwater table. In this research, to achieve aquifer quantitative and qualitative (QQ) sustainable development, an optimal scenario for withdrawing from operation wells is proposed. At the first step, the aquifer QQ simulation was carried out with the GMS model. The developed code in MATLAB2018b in the second step provides the link between the simulation and the NSGA-II optimization tools. In the third step, a multi-objective coupled optimization-simulation model based on GMS and NSGA-II developed. Finally, optimal scenario was chosen based on applying the multiple criteria decision-making (MCDM) and Berda Aggregation Method (BAM). The results show that reducing the current withdrawal rate to 51.55% can establish the QQ stability of the aquifer. This decrease in groundwater abstraction has led to a 4.6 m increase in groundwater level (GWL) over 3 years (average 19 cm per month). The spatial and temporal distribution of nitrate concentration after applying the optimal discharge of wells shows the nitrate concentration in central and eastern parts of the aquifer has greatly reduced. Developed sustainable management model can be used to provide a real operation planning of wells to improvement of the QQ status of groundwater in each unconfined aquifer., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Primary cardiac lymphoma (PCL) is a rare primary cardiac neoplasm with a relatively poor prognosis despite confinement to the heart and/or pericardium. We report a 54-year-old man who had presented with complete heart block for which he had undergone permanent pacemaker implantation, and six months later he was referred to us for evaluation of progressive exertional dyspnea. Multislice spiral computed tomography angiography of the heart and major vasculature showed infiltrative tumoral lesion that has involved interatrial septum, right atrium, left atrium, and left ventricle with invasion into the pulmonary artery. Tissue samples were taken using uniportal video-assisted thoracoscopic surgery, and the histologic examination revealed diffuse large B-cell lymphoma. Chemoimmunotherapy was effective in inducing tumor regression and the patient was still in remission during the next six months after treatment.

Land subsidence susceptibility mapping is a necessary prerequisite for land subsidence management. Proper assessment of land subsidence requires determining parameters affecting subsidence to discover the spatial relationships with subsidence. For this purpose, two frameworks were prepared, according to the land site subsidence, eight parameters affecting the subsidence in the Damaneh-Daran plain. In the first framework, eight parameters including annual groundwater level drawdown, aquifer medium, land use, discharge, aquifer saturation thickness, net recharge, fault proximity and topography called PWRSTFAL based on weighting parameters and the second model based on optimization and compatibility of eight active layers on subsidence, were prepared by AHP-fuzzy method and the final map of subsidence vulnerability obtained. Radar images and the InSAR method validated the methods. The results show that both maps show a good correlation with radar data. Still, the map prepared by the AHP-fuzzy method offers the highest correlation with radar data and subsidence in the plain. It separates subsidence vulnerability in more detail on the whole surface of the plain. According to this model, most plain areas, especially the eastern part, are subject to subsidence, and management programs should control subsidence. The results ROC diagram obtained from the performance of the PWRSTFAL framework based on the AHP-fuzzy method was more promising than the ordinary PWRSTFAL framework., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on diastolic function is less known. We describe a 46-year-old man with a history of mild hypertension who presented to the emergency department with fever, cough, and myalgia for 2 days. The patient was tested positive for SARS-CoV-2. He was admitted and started on a combination of antiviral and antimicrobial therapy. He developed respiratory distress 2 days later, and O 2 saturation declined. Blood tests showed an increased N-terminal pro-B type natriuretic peptide (NT-proBNP) level, and echocardiography showed normal left ventricular ejection fraction and E/e' ratio of 16. Computed tomography scan showed interstitial pulmonary oedema and prominent peripheral pulmonary vascular markings. Given these findings, heart failure with preserved ejection fraction (HFpEF) was considered. Low-dose diuretic was started, and fluid administration was restricted, resulting in a decrease in NT-proBNP level, clinical and haemodynamic stabilization, and improved oxygenation. This case highlights the occurrence of HFpEF in coronavirus disease 2019., (© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: The study aimed to evaluate the effectiveness and safety of BAE in TB patient with massive hemoptysis and evaluate the recurrence rate of hemoptysis after BAE., Materials and Methods: In this prospective study, 68 patients with moderate and severe hemoptysis due to active or old tuberculosis who underwent bronchial arteriography were included. CXR and CT scan were performed in all patients. Selective and nonselective bronchial artery angiography was performed in all patient and 62 patients underwent embolization., Results: Thirty-two patients (47.1%) had active TB and 36 patients (52.9%) had inactive TB (post-tuberculosis sequelae). Abnormality was detected in a single vessel in 30 (44.1%) patients, in two vessels in 23 (33.8%) and in more than two vessels in 13 (19.1%) patients. Embolization was performed in 62 patients and overall 95 abnormal arteries were embolized. Hemoptysis control rate was 82.3% at one month, 73.5% at three months, 69.1 % at 6 months, 63.2% at one year and 60.3% after two years., Conclusion: No major complication occurred as a result of BAE procedures. BAE is a safe and effective method for the management of hemoptysis in patient with tuberculosis. Only 20.6% of the patients need to repeat BAE during 2 years of follow up., (Copyright© 2021 National Research Institute of Tuberculosis and Lung Disease.)

Hospital medical errors that result in patient harm and death are largely identified as system failures. Most hospitals lack the tools to effectively identify most system errors. Traditional methods used in many hospitals, such as incident reporting (IR), departmental morbidity and mortality conferences, and root cause analysis committees, are often flawed by under reporting. We introduced the Code S designation into our hospital's ongoing physician peer review process as an additional and innovative way to identify system errors that contributed to adverse clinical outcomes. The authors conducted a retrospective review of all peer review cases from January 2008 to December 2011 and determined the quantity and type of system errors that occurred. System errors were categorized based on a modified 5M model which was adapted to reflect system errors encountered in healthcare. The Code S designation discovered 204 system errors that otherwise may not have previously been identified. The addition of the Code S designation to the peer review process can be readily adopted by other healthcare organizations as another tool to help identify, quantify and categorize system errors, and promote hospital-wide process improvements to decrease errors and improve patient safety., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Au et al.)

Background: We compared the severity of disease, heart failure (HF) rehospitalization and trend of changes over a 12-month follow-up in clinical and biochemical measurements between dilated cardiomyopathy (DCM) patients and those with left ventricular systolic dysfunction with normal LV size (NLVS). The existing definition of DCM failed to justify our observations in some clinical circumstances resulting in diagnostic and prognostic challenges., Methods: A total of 77 patients [52 (67.5%) male] including 40 patients in the NLVS group and 37 patients in the DCM group were enrolled and followed up for a median of 12 months [interquartile range, 11-14 months]., Results: Mean left ventricular ejection fraction was statistically comparable between NLVS and DCM patients (22 ± 8% vs. 19 ± 6%, P = 0.08]. The New York Heart Association class was statistically comparable in both groups (P = 0.23). Laboratory measurements including hemoglobin, sodium, creatinine, uric acid, and NT-proBNP level were also statistically similar in both groups (all P > 0.05). During follow-up, HF rehospitalization occurred in 16 (76%) patients in NLVS and 5 (24%) patients in DCM groups (P = 0.009). Except for left ventricular ejection fraction which improved in both NLVS and DCM groups, no significant changes were observed in clinical (New York Heart Association class) and laboratory measurements during follow-up in both NLVS and DCM groups., Conclusions: Our study showed that NLVS defines a group of systolic HF patients which not only did not have less severe disease than those with enlarged left ventricules (i.e., DCM), also had more HF rehospitalization. These NLVS patients also had steady clinical, laboratory, and echocardiographic profile during follow-up.

Background: The optimal treatment approach for spontaneous coronary artery dissection (SCAD) remains unclear., Objectives: The study aims to compare in-hospital and long-term clinical outcomes of SCAD patients initially managed with medical therapy (conservative approach) versus percutaneous coronary intervention or coronary artery bypass grafting (revascularization approach) based on published data., Methods: We identified relevant studies by performing a systematic search in the Ovid MEDLINE and Embase databases. Studies with N at least 10 that report in-hospital outcomes [death, myocardial infarction (MI) and revascularization] or long-term outcomes (death, MI, revascularization, SCAD recurrence, and heart failure) were included. Risk difference between conservative and revascularization approach was estimated with the inverse variance-weighted method in a fixed-effect or random-effect model., Results: A total of 22 nonrandomized, observational studies were analyzed (N = 1435). Compared with the initial revascularization approach, the conservative approach was associated with a comparable risk of in-hospital outcomes [risk difference: death, -0.61% (95% confidence interval, -2.13-0.91%), P = 0.43; MI, -0.99% (-4.65-2.67%), P = 0.60; revascularization, -3.02% (-8.79-2.75%), P = 0.31] and long-term outcomes [death, -0.06% (-2.33-2.20%), P = 0.96; MI, 0.96% (-2.35-4.27%), P = 0.57; revascularization, -3.31% (-7.63-1.02%), P = 0.13; SCAD recurrence, 3.75% (-2.05-9.55%), P = 0.21; heart failure, -0.01% (-3.13-3.11%), P = 0.99]. There was no significant heterogeneity across these studies., Conclusion: Pooled results suggest that SCAD patients initially managed with a conservative strategy may have similar in-hospital and long-term outcomes compared with those who received revascularization in the absence of ongoing ischemia or left main artery involvement. More data from prospective studies are warranted to validate these findings.

Atrial fibrillation (AF) is the most common arrhythmia and poses a substantial economic burden due to associated thromboembolic complications. Screening for AF may theoretically be effective, but there is no consensus regarding the optimal screening method because the available tools are either invasive or not cost-effective. Recently, smartwatch industry has received a surge of interest for this purpose by introducing technologies such as photoplethysmography, artificial intelligence, and actual electrodes taking an electrocardiogram to measure and analyze heart rate and rhythm with relatively acceptable accuracy. Combined with other features such as ease of use and connectivity, smartwatches can potentially be used for large-scale AF screening and might eventually replace the current gold standards. In this review, we discuss the feasibility of this approach and summarize the current evidence on AF detection with smartwatches.

The adult myocardium has a limited regenerative capacity following heart injury, and the lost cells are primarily replaced by fibrotic scar tissue. Suboptimal efficiency of current clinical therapies to resurrect the infarcted heart results in injured heart enlargement and remodeling to maintain its physiological functions. These remodeling processes ultimately leads to ischemic cardiomyopathy and heart failure (HF). Recent therapeutic approaches (e.g., regenerative and nanomedicine) have shown promise to prevent HF postmyocardial infarction in animal models. However, these preclinical, clinical, and technological advancements have yet to yield substantial enhancements in the survival rate and quality of life of patients with severe ischemic injuries. This could be attributed largely to the considerable gap in knowledge between clinicians and nanobioengineers. Development of highly effective cardiac regenerative therapies requires connecting and coordinating multiple fields, including cardiology, cellular and molecular biology, biochemistry and chemistry, and mechanical and materials sciences, among others. This review is particularly intended to bridge the knowledge gap between cardiologists and regenerative nanomedicine experts. Establishing this multidisciplinary knowledge base may help pave the way for developing novel, safer, and more effective approaches that will enable the medical community to reduce morbidity and mortality in HF patients.

Background: The prognostic role of the electrocardiogram (ECG) in PH is not fully known. We aimed to evaluate ECG abnormalities in severe PH, the association of ECG patterns with known prognostic factors and to determine whether ECG abnormalities were associated with decreased survival in patients with severe PH., Materials and Methods: Fifty-two patients with severe PH were included. Clinical assessment included basic demographics, complete physical examination, determination of WHO FC, measurement of N-terminal pro-BNP, 12-lead electrocardiography, transthoracic echocardiography, right heart catheterization (RHC) and six minute walk test (6MWT)., Results: Heart rate was correlated with NT-proBNP (r=0.54; p-value: 0.0001) and was higher in patients with severe RV dysfunction (93±12 vs. 83±4 bpm in moderate RV dysfunction). P-pulmonale was present in 51.9% of the patients and was significantly associated with severe RV dysfunction. qR in V1 (48.1%) was significantly associated with 6MWT and severe RV dysfunction. Overall, 10 patients died. Based on Kaplan-Meier results, median survival time was 38 months and estimated survival at 1 year, 3 years, and 5 years was 88%, 80% and 71 % respectively. In Cox regression analysis WHO FC, 6MWT, pericardial effusion, NT-pro BNP, heart rate, ST depression in V1 to V3, and presence of qR in V1 were predictors of mortality. After controlling for covariates, only NT-proBNP was independently associated with decreased survival., Conclusion: ECG changes including P-pulmonale, qR pattern in V1, and heart rate indicative of right ventricular dysfunction are associated with prognostic factors in severe PH and may be a useful tool in the follow-up.