Cutaneous tuberculosis presented by chest wall fistula formation

زمینه و هدف: سل یک معظل بهداشتی جهانی است که از نظر سازمان جهانی بهداشت (WHO) در راس شش بیماری شایع عفونی خطرناک قرار دارد. گرچه یکی از هر سه نفر مردم در دنیا آلوده به مایکوباکتریوم توبرکولوزیس هستند ولی سل پوستی بیماری نادری است. در این مطالعه ما به معرفی یک مورد نادر سل پوستی با تظاهر فسیتول متعدد مزمن در جدار قفسه سینه می پردازیم. گزارش مورد: مردی 50 ساله افغانی با سابقه دیابت وابسته به انسولین که با شکایت ضایعه پوستی به شکل فیستول در پوست ناحیه قفسه سینه از 3 ماه قبل مراجعه نمود. شروع ضایعه به صورت پاپول بوده که پس از مدتی فیستولیزه شده و همراه با سوزش و ترشح چرکی بوده است. با توجه به سیر طول کشیده بیماری و عدم پاسخ به درمان با آنتی بیوتیک و ملیت بیمار، سل پوستی در راس تشخیص های بیمار قرار گرفت و با توجه به مشاهده گرانولوم های متعدد متشکل از هیستوسیت ها، ژانت سل های تیپ لانگهانس در بیوپسی پوست و مشاهده باسیل های متعدد اسید فاست در اسمیر با رنگ آمیزی زیل نلسون از ترشحات فیستول ها تشخیص سل پوستی قطعی شد و بیمار تحت درمان با داروهای ضد سل قرار گرفت که علایمی از بهبودی نسبی پس از 6 هفته و بهبودی کامل پس از 6 ماه ملاحظه گردید. نتیجه گیری: سل پوستی می تواند به اشکال بسیار غیر معمول از جمله فیستول در هر محلی از جمله جدار قفسه سینه تظاهر کند. لذا باید در تشخیص افتراقی ضایعات جلدی طول کشیده همراه با تشکیل فیستول این بیماری مد نظر قرار گیرد.

Evaluating the drinking waters microbial flora of reverse osmosis treatment systems in kashan city during summer and autumn (2015)

According to the various difficulties of Distillation desalination system,currently the membrane technology such as Reverse Osmosis (RO) is more useful. High concentration of dissolve solids in supplying water resources in Kashan caused a bad taste and reduced the consumer’s desire for using such water,and often they used treated water in a way that at the conducting time of this study,20 centers treated the water by RO method in the city. Therefore,this study evaluated the microbial flora of produced drinking water of RO treatment system in Kashan city during summer and autumn 2015. In this study the census method have used and the sampling have done from all the RO water treatment centers of the city. Three input,output and after storage,samples have taken. The evaluation of the temperature,residual chlorine,TDS,the storage time,and RO membrane operation time in samples have done. The HPC test has done on the samples in the laboratory and the positive plates have identified in terms of bacterial spices. The tests have repeated in four months of the year from July to October. The results showed 95% residual chlorine in the input samples and the HPC test for these samples showed no contamination. The sample contamination after treatment and the tank were 8 and 15% respectively. In addition,the most contamination level have related to September,which the samples temperature in this month reach its highest level. The Pearson coefficient results showed that there was a significant relation between the Heterotroph colonies number and the residual chlorine and temperature parameters,which was consistent with Karami et al. in Kermanshah and Dobaradaran et al. in Esfahan studies. In addition,there was a significant relation between the Heterotroph colonies number and storage time and RO membrane operation time

Assessment of perceived social support among selected hospital personnel in Isfahan

كي از مهمترين شرايط براي عملكرد مؤثر سازمانها، فراهم بودن عامل انساني است. در اين ميان، حمايت اجتماعي يـک عامـل روانشناختي مهم در محيط کار ميباشد که بر عملكرد نيروي انساني تاثيرگذار است. لذا اين مطالعه با هدف تعيين حمايت اجتمـاعي درک شده در بعد پشتيباني عاطفي در ميان کارکنان بيمارستان انجام شد. در اين مطالعهي مقطعي، ۱۲۰ نفر از کارکنان يک بيمارسـتان منتخب در شهر اصفهان به روش نمونهگيري در دسترس جهت بررسي انتخاب شدند. گردآوري اطلاعات با استفاده از پرسشنامههاي مشخصات فردي و حمايت اجتماعي كه محقق ساخته بود، انجام شد. روايي ابزار با اسـتفاده از روايـي محتـوا و پايـايي آن بـا روش بازآزمايي اخذ شدند و در نهايت دادهها با استفاده از آمار توصيفي و استنباطي (آزمون مجذورکاي) مورد تجزيه و تحليل قرار گرفتند. يافتهها نشان داد، حمايت اجتماعي درک شده در بعد پشتيباني عاطفي از سوي همکاران با ميـانگين نمـرهي ۹/۰ ± ۳۴/۳ بـيشتـر از حمايت اجتماعي درک شده در همين بعد از سوي مديران با ميانگين نمره ۸۸/۰ ±۵۸/۲ بوده است. همچنين، بين حمايت اجتماعي در بعد پشتيباني عاطفي با مشخصات فردي مثل سن و سابقهي کار مطابق آزمون square-Chi دو رابطهي معنيدار آماري وجـود داشـت (05/0<P .(با توجه به آنكه حمايت اجتماعي از کارکنان بيمارستان براي عملكرد مؤثر سازماني الزامي اسـت، مـديران بيمارسـتانهـا ميتوانند از طريق تحکيم روابط خود با کارکنان بر افزايش کارايي آنها مؤثر باشند

Diagnostic value of Neuron-Specific Enolase (NSE) and Cancer Antigen 15-3 (CA 15-3) in the Diagnosis of Pleural effusions

Introduction: Pleural effusion diagnosis plays an important role in determining treatment strategies. The aim of this study was to determine the diagnostic capacity of tumor markers CA 15-3 and NSE solely or in combination in differentiating the nature of pleural fluid. Methods and Materials: In this cross-sectional study we evaluated 93 patients with pleural effusions (44 malignant and 49 benign). NSE and CA 15-3 serum and pleural levels were measured simultaneously using immunoenzyme assay kits. Diagnosis was established on the basis of cytological study. Results: Sensitivity and specificity of CA 15-3 serum and pleural level measurement were 70.4%, 49.0%, and 79.5% and 49.0%, respectively. Serum NSE levels had 75.0% sensitivity and 69.4% specificity while the respective pleural figures were 75.0% and 73.5%. The combination of NSE and CA 15-3 serum and pleural levels had the highest sensitivity (93.2%), although combined serum levels had the lowest sensitivity (47.7%). With an accuracy of 74.2%, pleural levels of NSE had the highest diagnostic potential. Conclusion: Measuring NSE and CA 15-3 tumor markers is a suitable approach to distinguish the nature of pleural effusions, with NSE pleural levels demonstrating the highest diagnostic accuracy

Power Relations: Mario Vargas LIosa’s The Feast of the Goat

The notion of ‘power’ is one of the most debatable notions in sociological studies, and this is because of its inevitable presence in social relations and interactions. In all his relations within the society, man can feel the influence of power, either as the one in power or as the powerless one. Power does not exist in vacuum and it should be considered in relation with other social concepts such as class, race, gender, space, etc. Along with these concepts, different embodiments of power in the society can be revealed and different models of exercising of power will be formed. One of the most directly related notions to power is the notion of ‘politics’. What allows politicians to use different policies is power and what gives them power to fulfill their will and impose their own desire and interests on the other is politics. The other concept which serves these two notions is ‘discourse’. It is obvious that without ‘discourse’ and ‘language’ the existence of ‘power’ and ‘politics’ is only a probability, because ‘discourse’ is the means of exercising the power and applying the politics. Thus, here is a triangle of ‘power’, ‘politics’, and ‘discourse’. In this regard, a very brief historical overview of power is given. The base of discussion and analysis in this article is the different forms of power according to S. Westwood’s Power and the Social. This article explores the relation between the three angles of the mentioned triangle in Liosa’s The Feast of The Goat, a dictator–historical novel set in Dominican Republic. This study investigates various shapes of power exercised by Dominican dictator Rafael Leónidas Trujillo through politics and discourse.Key words: Power; Race; Class; Gender; Space; Vision; S. Westwood; Mario Vargas LIosa; The Feast of the Goa

The Effectiveness of Teaching Using Virtual and Flipped Classrooms In Developing Achievement Among First Secondary Female Students on History in Qasr District

The study aimed to know the effectiveness of teaching using virtual classrooms and flipped classrooms in developing the achievement of first-year secondary students in the subject of history in Qasr District. To achieve the objectives of the study, the quasi-experimental approach was adopted, where the study was conducted on an experimental group consisting of (23) students who were taught through virtual classes and an experimental group consisting of (22) taught by flipped classrooms, where the choice was by the intentional way, they were distributed among two study divisions randomly from the first year secondary students Serfa Secondary School for the academic year 2020/2021 AD. To collect the study data, an achievement test was prepared. The validity and reliability of this tool were verified before its application and the results of the study showed that there were statistically significant differences in favor of flipped classes and development of achievement. According to the results of the study, the researcher recommends conducting more studies in the field of virtual classrooms and flipped classrooms. Keywords: Achievement , Flipped Classes, Virtual Classes. DOI: 10.7176/JEP/12-31-05 Publication date: November 30th 202

Relationship between Periodontal Status and Associated Factors in Pregnant Women in Kashan; a Cross-sectional Study

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Background: Hormonal changes during pregnancy may act as a modifying factor of the pathogenesis of periodontal disease, being reported as a potential risk factor of adverse pregnancy outcomes. This study was accomplished to investigate the level of periodontal disease in pregnant women and to identify associated risk factors in a population of pregnant women in Kashan in 2017. Material and methods: A total of 128 pregnant women in the second and third trimester of pregnancy were recruited. Demographic data, oral health behaviors and socioeconomic status were determined by using a standard questionnaire. The periodontal condition was evaluated by Community Periodontal Index (CPI), Clinical Attachment Loss (CAL) and Bleeding on Probing (BOP) indices. Results: The mean (standard deviation) age of the samples was 24.35 (3.4). More than half of the participants (53.1%) were in the second trimester of pregnancy. A quarter of pregnant women had visited a dentist within the past year, of which more than 74% visit the dentist for pain or treatment. About half of the participants (50.8%) brushed their teeth daily, but only 10% of mothers had daily flossing habit. Periodontal screening is typically done using the Community Periodontal Index (CPI). Calculus had the highest score (49.2%) prevailing among the subjects, while prevalence of periodontitis (pocket depth&gt;=3) was 35.2%. Pocket depth &gt;3mm was more frequent in women with academic education, good socioeconomic status, women without history of pain, women who brush their teeth twice a day or more and women who visit the dentist&nbsp; (P &lt;0.05). Conclusion: The findings of the present study shows that all the studied factors are considered as risk factors for periodontal disease in pregnant women

Modeling and Uncertainty Analysis of Groundwater Level Using Six Evolutionary Optimization Algorithms Hybridized with ANFIS, SVM, and ANN

In the present study, six meta-heuristic schemes are hybridized with artificial neural network (ANN), adaptive neuro-fuzzy interface system (ANFIS), and support vector machine (SVM), to predict monthly groundwater level (GWL), evaluate uncertainty analysis of predictions and spatial variation analysis. The six schemes, including grasshopper optimization algorithm (GOA), cat swarm optimization (CSO), weed algorithm (WA), genetic algorithm (GA), krill algorithm (KA), and particle swarm optimization (PSO), were used to hybridize for improving the performance of ANN, SVM, and ANFIS models. Groundwater level (GWL) data of Ardebil plain (Iran) for a period of 144 months were selected to evaluate the hybrid models. The pre-processing technique of principal component analysis (PCA) was applied to reduce input combinations from monthly time series up to 12-month prediction intervals. The results showed that the ANFIS-GOA was superior to the other hybrid models for predicting GWL in the first piezometer and third piezometer in the testing stage. The performance of hybrid models with optimization algorithms was far better than that of classical ANN, ANFIS, and SVM models without hybridization. The percent of improvements in the ANFIS-GOA versus standalone ANFIS in piezometer 10 were 14.4%, 3%, 17.8%, and 181% for RMSE, MAE, NSE, and PBIAS in the training stage and 40.7%, 55%, 25%, and 132% in testing stage, respectively. The improvements for piezometer 6 in train step were 15%, 4%, 13%, and 208% and in the test step were 33%, 44.6%, 16.3%, and 173%, respectively, that clearly confirm the superiority of developed hybridization schemes in GWL modeling. Uncertainty analysis showed that ANFIS-GOA and SVM had, respectively, the best and worst performances among other models. In general, GOA enhanced the accuracy of the ANFIS, ANN, and SVM models.Comment: 42 pages, 11 figure