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Tony Zitek,1 Mani Hashemi,2 Sara Zagroba,2 Valori H Slane2 1Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA; 2Department of Emergency Medicine, Kendall Regional Medical Center, Miami, FL, USACorrespondence: Tony Zitek, Department of Emergency Medicine, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, 33140, USA, Tel +1-305-674-2121 Ext 56632, Email Zitek10@gmail.comPurpose: Acute aortic dissection (AAD) is a highly fatal disorder if not promptly diagnosed. Some international studies have suggested that serum d-dimer levels may be used to exclude AAD, but data are limited. We sought to confirm that d-dimer levels are elevated in American patients with AAD. Additionally, we sought to estimate the test characteristics of the d-dimer for AAD.Patients and Methods: We performed a retrospective analysis of patients in the Hospital Corporation of America database who arrived at the hospital between 2015 and 2019. We queried the database to find patients who had a diagnosis of AAD or (nonspecific) chest pain, and who also had a d-dimer performed within 24 hours of arrival at the hospital. The median d-dimer was compared in those diagnosed with AAD versus chest pain. We estimated the test characteristics of d-dimer for AAD at the standard cutoff value of 500 ng/mL.Results: In total, 48,902 patients met the criteria for analysis, including 572 with AAD and 48,330 with chest pain. The median d-dimers were 2455 ng/mL and 385 ng/mL for the AAD and chest pain groups, respectively (p < 0.0001). Using a cutoff of 500 ng/mL, the sensitivity of the d-dimer was 91.1% and the specificity was 71.4%.Conclusion: Serum d-dimer values are higher in patients with AAD than in those with nonspecific chest pain. At the standard cutoff of 500 ng/mL, the serum d-dimer has a high sensitivity for AAD, but not high enough that d-dimer levels alone can be used in isolation to exclude AAD.Keywords: aorta, dissection, d-dimer, diagnosis

Kate Nguyen,1 Dinh Bui,2 Mahak Hashemi,1,3 Dianna M Hocking,4 Priyan Mendis,3 Richard A Strugnell,4 Shyamali C Dharmage2 1School of Engineering, RMIT University, Melbourne, Victoria, Australia; 2Centre of Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia; 3ARC Training Centre on Advanced Manufacturing of Prefabricated Housing, The University of Melbourne, Melbourne, Victoria, Australia; 4Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, AustraliaCorrespondence: Shyamali C Dharmage Email s.dharmage@unimelb.edu.auAbstract: This work is part of a project on the development of a smart prefabricated sanitising chamber (SPSC) to provide extra measures against the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Stabilised hypochlorous acid (HOCl) is an approved disinfectant against SARS-CoV-2 by the Environmental Protection Association US in its liquid form on non-porous surfaces. This review is extended to cover its viricidal/bactericidal efficacy in aerosolised or sprayed form which showed an effective dose of as low as 20 ppm and the exposure duration of at least 60 s. The aerosolised application was also recommended with particle size of less than 200 μm to increase the contact with pathogens. The review also includes the safety and toxicity of HOCl with different concentrations. The review calls for more investigations into the effect of HOCl in mist and fog form on the respiratory system when transitioning through the proposed SPSC.Keywords: SARS-CoV-2, Sanitiser, occupational health, cross-contamination, healthcare management

Fariborz Akbarzadeh,1 Leili Pourafkari,1 Samad Ghaffari,1 Mohammad Hashemi,2 Homayoun Sadeghi-Bazargani3,41Cardiovascular Research Center of Tabriz University of Medical Sciences, 2Isfahan University of Medical Sciences, 3Traffic Injury Prevention Research Center, Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran; 4PHS Department, Karolinska Institute, Stockholm, SwedenBackground: Fragmented QRS encompasses different RSR' patterns showing various morphologies of the QRS complexes with or without the Q wave on a resting 12-lead electrocardiogram. It has been shown possibly to cause adverse cardiac outcomes in patients with some heart diseases, including coronary artery disease. In view of the need for risk stratification of patients presenting with acute coronary syndrome in the most efficacious and cost-effective way, we conducted this study to clarify the value of developing fragmented QRS in a cohort of patients presenting with their first acute coronary syndrome in predicting 6-month mortality and morbidity.Methods: One hundred consecutive patients admitted to the coronary care unit at Shahid Madani Heart Center in Tabriz from December 2008 to March 2009 with their first acute coronary syndrome were enrolled in this prospective study. Demographic and electrocardiographic data on admission, inhospital mortality, and need for revascularization were recorded. Electrocardiography performed 2 months after the index event was examined for development of fragmented QRS. Mortality and morbidity was evaluated at 6-month follow-up in all patients.Results: The patients were of mean age 57.7 ± 12.8 years, and 84% were men. The primary diagnosis was unstable angina in 17 (17%) patients, non-ST elevation myocardial infarction (MI) in 11 (11%), anterior or inferior ST elevation MI in 66 (66%), and postero-inferior MI in six (6%). Fragmented QRS was present in 30 (30%) patients during the first admission, which increased to 44% at the 2-month follow-up and to 53% at the 6-month follow-up. The presence of various coronary risk factors and drug therapy given, including fibrinolytic agents, had no effect on development of fragmented QRS. Mortality was significantly higher (P = 0.032) and left ventricular ejection fraction was significantly lower (P = 0.001) in the fragmented QRS group at the 6-month follow-up.Conclusion: This study strongly suggests that fragmented QRS on initial presentation with acute coronary syndrome is not predictive of subsequent events but, if present 6 months later, could be predictive of an adverse outcome.Keywords: acute coronary syndrome, fragmented QRS, electrocardiography, mortality, left ventricular function

Abstract Background and objectives: Microbial, physical and chemical properties of drinking water, considering type and quantity of the drinking water, are the factors for determining the acceptability of water. The effect of each of the above components on increasing the quality of water or threatening the health of consumers is also considerable. We aimed to investigate the trace amounts of microbial, physical and chemical parameters of drinking water in Gorgan, comparing to national and international standard. Material and Methods: In this cross sectional study, 50 samples were taken, per month, from four pilot stations in urban water network of Gorgan during one year (2009- 2010). We used instant sampling and performed Enumeration of Coliforms in water culture with most probable number (MPN).Samples taken from the stations during the month were investigated in two general categories of device test and heading-meter. All experiments were performed using standard reference method. Results: of 598 water samples 551 (92.2%) have not Coliforms, 47 (7.8%) contain Coliforms and 16 (2.7%) of them have thermo-tolerant Coliforms. Mean water hardness is 413mg/L, base on carbonate calcium. The amount of fluoride about 0.35 mg and the residual chlorine about 0.6 mg is less than national standard amount. Conclusion: The results show that Gorgan water network is, in view of microbial contamination, safe during almost all days. All the tested samples in terms of physical and chemical parameters are in the range of nation and international standards. Hardness of drinking water of Gorgan is one of the highest. Key words: Bacteriological, Physiochemical, Drinking Water, Gorgan.

"n Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: The transfer of multiple embryos during ART procedures (IVF/ICSI) in order to maximize the chance of pregnancy, has resulted in increasing rates of multiple pregnancies with a 20- fold increased risk of twins and 400- fold increased risk of higher order pregnancies with significantly high maternal and perinatal morbidity and mortality in comparison with singleton. Since at present there is no limitation in number of embryos being transferred in ART cycles in infertility centers in Iran, in order to evaluate the relationship between number of embryos transferred, pregnancy rates and multiple pregnancy, this study was performed in a referral university center."n"n Methods: In a cross sectional descriptive analytical study a total of 536 ART cycles in infertile patients treated at the Infertility Department of Vali-e-Asr Hospital & Vali-e-Asr Reproductive Health Research Center from October 1999- March 2003 were evaluated using a questionnaire dealing with the parameters affecting ART outcome."n"n Results: There was a total pregnancy rate of 21% with a multiple pregnancy rate of 12%. Increased age had a negative effect on pregnancy rate with a significant difference over 40 years (p

One of the dangerous complications of cataract extractions is vitreous loss. The purpose of this stuy is to evaluate the incidence of vitreous loss and its sepuale while teaching residents at Rasoul Akram Hospital in Iran. This study has been conducted on existing records of 730 eyes which were subjectd to extracapsular cataract extractions by 3rd and 4th year, right handed resident of Rasoul Akram hospital. The information was taken from the records of patients who had vitreous loss during cataract surgery and the following data was extracted. The presence of any systemic diseases, phase of operation where vitreous loss occurred, vision on the next day, one month and 3 months later, the cause of low vision and any post operative sequale of the eye were evaluated. Extracted data collected and the prevalence of vitreous loss and its sequale were indentified and presented. Forty-nine eyes (6.7%) had vitreous loss, thirty-one of them were in the left eye (63.3%) and eighteen of them were in the right eye (36.7%). Regarding the stage of operation in which vitrous loss had occurred: twenty –eight eyes while nucleous delivery (57.7%) eighteen eyes during aspiration of cortical material (36.7%) and in three cases during IOL implantation. Five eyes had pseudoexfoliaton syndrome, four patients were diabetic and three had high myopia. Post operational sequale of these 49 eyes were: thirty-five with transient corneal edema (71.4%). Nine with misshaped pupils (18.9%), four with high astigmatism (8.1%), tow with cystoid macular edema (4%), two with retinal detachment (4%) and seven with cloudy vitreous. (14.3%). The incidence of vitreous loss is more than expected. More extensive research to evaluated the prognositc factors according to the eye (OD/OS) and the stage of the operation the leads to vitreous loss and to decrease its incidence is still needed.

Despite unwillingness to fertility, about 30% of couples do not use any kind of contraception and this will lead to unwanted pregnancy. In this clinical trial study, 4177 subjects who had at least one alive child, and delivered in one of the 12 university hospitals in Tehran were recruited. This study was conducted in 1996. The questionnaire included some questions about contraceptive use, their attitudes about unwantedness or wantedness of their current pregnancies. Data were analysed using a Logistic Regrassion Model. Results showed that 20.3% of those who had no fertility intention, did not use any kind of contraception methods, 41.1% of the subjects who were using a contraception method before pregnancy, had got pregnant unwantedly. Based on Logistic Regression Model; age, education, previous familiarity of women with contraception methods and husband's education were the most significant factors in contraceptive use. Subjects who were 20 years old and less or 35 years old and more and illeterate subjects were at higher risk for unuse of contraception methods. This risk was not related to the gender of their children that suggests a positive change in their perspectives towards sex and the number of children. It is suggested that health politicians choose an appropriate model to enhance the literacy, education and counseling for the correct usage of contraceptives and prevention of unwanted pregnancy.