Prevalence of mental disorders among middle-aged population of primary healthcare centers in Northeastern Iran.

BACKGROUND: Primary healthcare centers (PHCs) serve as the cornerstone of accessible medical services in society, playing a crucial role in screening, detecting, and treating various health issues. This study aimed to investigate the prevalence of psychiatric disorders in middle-aged individuals who refer to PHCs and the potential of PHCs in diagnosing mental disorders. METHODS: This cross-sectional study was implemented at PHCs under the supervision of Mashhad University of Medical Sciences (MUMS) in northeast Iran in 2018. The enrolled subjects were middle-aged adults who had electronic medical records in SINA, an integrated health management system, and the electronic medical records of MUMS. The prevalence of psychiatric disorders by type and their relationship with demographic information was evaluated by a Chi-square test using SPSS 22. RESULTS: This study involved 218,341 middle-aged participants. Prevalence of psychiatric disorders was 8.59%, and depression (53.72%) and anxiety (42.02%) were the most common psychiatric disorders in both males and females. The prevalence of mental disorders was significantly higher in females than in males (88.18% vs. 18.81%; P < 0.0001). Indeed, a significant higher prevalence of depression, anxiety, somatoform, childhood psychiatric disorder, and bipolar disorders was observed in females compared to males (P < 0.05). In addition, individuals between the age of 45-60 years, and those from rural areas showed more prevalence of mental disorders than others, but these differences were not significant. CONCLUSIONS: Considering the previous studies in Iran, the prevalence of mental disorders among patients presenting to PHCs was noticeably lower than expected rates. It seems probable that this huge difference is due to poor screening and detection of mental illness in PHCs of MUMS. It is recommended that health policymakers pursue specific measures to make PHCs more helpful for people with mental health problems in the community.

Evaluation the quality of bag-mask ventilation by E/C, T/E and hook technique (a new proposed technique).

BACKGROUND: Bag-Mask Ventilation (BMV) is a crucial skill in managing emergency airway situations and induction of general anesthesia. Ensuring proficient BMV execution is imperative for healthcare providers. Various techniques exist for performing BMV. This study aims to compare the quality of ventilation achieved using the E/C technique, Thenar Eminence (T/E) technique and a novel approach referred to as the hook technique. The goal is to identify the most effective single-person BMV method. METHOD: We conduct a pilot study on manikins involving 63 medical staff members who used the hook technique for ventilation. Subsequently, we obtained ethical approval and patient guardian consent to perform the study on 492 emergency department (ED) patients. These patients were randomly divided into three groups, with each group subjected to one three ventilation techniques. The study focused on patients requiring reliable airway management for rapid sequence intubation (RSI). Ventilation was administrated using bag-mask device connected to the capnograph. End-tidal CO2 (ETCO2) levels were recorded. Demographic data were collected and analyzed by SPSS software version 22. Success rates were reported as frequency (percentage) as well as mean ± standard deviation. RESULT: Comparing partial pressure of CO2 (PCO2) results obtained via capnography between T/E, E/C and hook techniques, we found that the successful ventilation rate was 87.2% for T/E, 89.6% for E/C, and 93.3% for the hook methods. The hook method demonstrated significantly higher success rate compared to the other two techniques (P-value = 0.038). Furthermore, we observed statistically significant trends in PCO2 changes between measurements both within and between groups (P-value < 0/001). CONCLUSION: Our study indicates that the hook method achieved notably higher success rate in ventilation compared to the T/E and E/C methods. This suggests that the hook method, which involves a chin lift maneuver while securely fitting the mask, could serve as a novel BMV technique, particularly for resuscitation with small hands for a prolonged use without fatigue and finger discomfort. Our finding contributes to the development of a new BMV method referred to as the hook technique. TRIAL REGISTRATION: IRCT registration number: IRCT20121010011067N5. URL of trial registry record: https://www.irct.ir/trial/57420 .

Treatment of high dose of intravenous midazolam abuse: a case report.

This study reports a rare case of high-dose midazolam abuse and Munchausen Syndrome. A 48-year-old female physician was referred by a psychiatrist to the Toxicology Department of Imam Reza Hospital for abstaining from 300 mg/day of parenteral midazolam. She had mimicked the symptoms of Crohn's disease; therefore, she had undergone 15 colonoscopies and 40 times MRI or CT scan, all of which were normal. Six months earlier, she had switched oral methadone to 30 mg/day of intravenous midazolam. She also had several skin lesions on injection sites that she considered pyoderma gangrenosum. When the total daily dose of intravenous midazolam was switched to oral bioequivalence of clonazepam, she could not tolerate withdrawal (Clinical Institute Withdrawal Assessment Scale-Benzodiazepines = 68). Therefore, she received midazolam again as a continuous intravenous infusion. Within 7 days, the whole dose was replaced by the bioequivalence oral dose of clonazepam. She was also treated with carbamazepine and cognitive behavior therapy. Afterward, she was transferred to the psychiatric ward for further psychiatric treatment. Dependency on a high dose of midazolam could be treated by tapering off the long-acting benzodiazepine.

Epidemiological aspects of individuals with mental disorders in the referral system: the experience of a Community Mental Health Center in the northeast of Iran.

BACKGROUND: Community Mental Health Centers (CMHCs) offer affordable mental health services in a less stigmatized environment, in a domiciliary setting. This study aimed to shed light on the epidemiological factors of patients attending CMHCs of Mashhad, their referral status, and treatment. METHODS: This study was conducted over the medical records of patients seen by psychiatrists between January 2014 and December 2021 in Mashhad's CMHC, the northeast of Iran. A detailed questionnaire was used to extract data from medical records about the epidemiological characteristics, diagnosed mental illnesses, referral status, and how often they visited the psychiatrist. The association between epidemiological findings and patient referral (referral system or self-referral) as well as the association between epidemiological findings and the number of psychiatric revisits were examined using the Chi-square test. RESULTS: Out of 662 patients, 472 (71%) were female and 190 (29%) were male, with an average age of 29 years. Among the 475 adult patients, 367 (77.3%) were married, with the majority being homemakers (56.4%). Major Depression Disorder (MDD) (32%) and Generalized Anxiety Disorder (GAD) (18.3%) were the most prevalent mental health conditions among patients. The majority of patients (74.9%) were referred to the CMHC of Mashhad from Primary Healthcare centers (PHCs) and psychiatric hospitals. Furthermore, female gender and patients with lower level of education were associated with more referral through from referral system. Of note, 431 patients (65.1%) did not return for a second visit, the ratio of treatment dropout was higher for patients with lower education levels. CONCLUSIONS: Referral system should be more practical in Iran to enhance health services in CMHCs. It is recommended that PHCs undergo certain modifications to enhance the referral process for patients with mental health conditions, focusing on common mental disorders and individuals with low socioeconomic level.

Catalytic evaluation of promoted CeO2-ZrO2 by transition, alkali, and alkaline-earth metal oxides for diesel soot oxidation.

Series of mixed metal oxides were synthesized by gel-combustion method and their catalytic activities for soot oxidation were investigated. The catalysts were M-Ce-Zr (M = Mn, Cu, Fe, K, Ba, Sr), and xK-20Mn-Ce-Zr (x = 0, 5, 10, 20), they were characterized by XRD, SEM, TPR and BET surface area techniques. The results of soot temperature programmed oxidation (TPO) in an O2 oxidizing atmosphere indicate that K-Ce-Zr has the highest catalytic activity for soot oxidation under loose contact condition, due to enhancement of the soot and catalyst contacts. On the other hand, under a tight contact condition, Mn-Ce-Zr and Cu-Ce-Zr nano-composites have high activities for soot oxidation and lower the soot TPO peak temperatures by about 280 and 270 degrees C, respectively, as compared to non-catalytic soot oxidation. Furthermore, the addition of up to 10 wt.% potassium oxides into Mn-Ce-Zr increases its catalytic activity and further reduces the soot TPO peak temperature by about 40 degrees C under loose contact condition.

Addressing food insecurity: An exploration of wheat production expansion.

Wheat plays a crucial role in global food security, serving as a vital food crop that feeds billions of people worldwide. Currently, Russia and Ukraine are responsible for exporting approximately 25% of the world's wheat, making any issues in these regions a cause for concern regarding global wheat supply. The problems faced in these areas have led to a surge in wheat prices worldwide. Consequently, it becomes necessary to explore alternative regions that can compensate for the decline in wheat production and supply. This study focuses on wheat production and yield in major producing countries, utilizing the GYGA (Global Yield Gap Atlas) protocol for predictions. The findings reveal a global wheat production gap of 270,378,793 tons. Notably, the largest gap in irrigated wheat production exists in countries like China, India, Pakistan, Turkey, Iran, Afghanistan, Uzbekistan, Egypt, and Azerbaijan. Additionally, the rainfed wheat production gap on a global scale amounts to 545,215,692 tons, with Russia, the USA, Kazakhstan, Australia, Ukraine, China, Turkey, Canada, India, and France having the most significant production gaps. Through boundary line analysis, specific criteria were identified for suitable areas of irrigated and rainfed wheat cultivation. For irrigated conditions, the temperature range of 3000 to 7000 GDD (Growing Degree Days) and a temperature seasonality of 3 were determined as favorable. Under rainfed conditions, the suitable areas encompass a temperature range of 2000 to 4000 GDD, an aridity index exceeding 600, and a temperature seasonality of 2. Thirteen countries possess extensive agricultural land within the climatic codes favorable for irrigated wheat cultivation. Approximately 50% of the agricultural lands within these countries, corresponding to the total arable area for irrigated wheat, fall within the climatic codes 3403, 5403, 5303, 4303, 5503, 5203, 3503, 3303, and 4103. China, the United States, Ukraine, Russia, and Iran are the top five countries with favorable lands for irrigated wheat cultivation. Similarly, fourteen countries have significant agricultural lands within the favorable climatic codes for rainfed wheat cultivation. Around 52% of the agricultural lands within these countries are within the climatic codes 3702, 2702, 2802, and 4602. France, Germany, Britain, Poland, and Denmark possess the highest potential to expand rainfed wheat cultivation areas within these favorable climate codes, with respective areas of 2.7, 2.6, 1.6, and 0.9 million hectares. According to the study, the North China Plain emerges as a primary region for increasing irrigated wheat production, both in terms of cultivated area and yield potential. For rainfed conditions, the European continent stands out as a significant region to enhance wheat production.

Global insight into understanding wheat yield and production through Agro-Ecological Zoning.

Global food security requires food production to be increased in the future decades. Agro-Ecological Zones (AEZ) methodology is a successful approach used in land evaluation studies to support sustainable agricultural development. This approach can facilitate finding suitable areas for wheat production on a global scale. This study was conducted based on a climate zone map, soil data, wheat cultivation area, yield, and production under irrigated and rainfed conditions, worldwide. The results for irrigated wheat indicated that there is an area of 59.5 Mha with an average yield of 4.02 t/ha which leads to the production of about 239.6 Mt of grain yield. Furthermore, climate zones (CZs) of 8002, 5203, 5302, 5403, and 8102 have the highest wheat production with an average of 20.7, 14.2, 13.3, 11.8, 11.5 Mt, respectively. The highest amount of irrigated wheat production has been achieved in soil type code 17 (Loam LF120), which has a cultivation area of around 23.6 Mha and a production of about 106.8 Mt. Rainfed wheat production is 410 Mt, and the cultivation area is 160.2 Mha. The highest rainfed wheat production with an average of 17 Mt was related to the 3702 CZ, followed by the other CZs (3802, 1303, 1203, 3602, 4602, etc.). The soil codes 11 (Loam HF120), 10 (Loam HF180), and 14 (Loam MF120) showed the highest rainfed wheat production. The findings of this study can be useful for agricultural scientists, authorities, and decision-makers around the world to find suitable lands to expand wheat cultivation and also to find new locations for increasing global wheat production to feed the increasing population in the world.

Gastric Obstruction by Opium Packets: A Case Report.

Background: We reported a case of gastric obstruction in a body packer who swallowed a large number of opium packets. Case Report: A 36-year-old man opium addict visited the emergency department with epigastric pain for three days. He swallowed nearly 90 packets of opium for smuggling purposes four days earlier. He self-administered laxatives. In contrast, many times vomiting, he defecated only four packets and vomited one packet. The abdominal X-rays showed some amounts of fluid-air levels and multiple cylindrical opacities with the double-condom sign, corresponding to the distended stomach. Due to the worsening of his abdominal symptoms, he underwent an urgent laparotomy and 84 packets (4-6 cm in size and 8-10 g/ packet of opium) with a total weight of 870 g. They were wrapped in some layers of plastic and tied at the ends. He was discharged in stable condition. Conclusion: A large number of ingested drug packets can induce gastrointestinal obstruction.