Mediastinal malignant rhabdoid tumor in an infant: A rare case report.

Mediastinal malignant rhabdoid tumor (MRT) is an exceedingly rare and aggressive neoplasm, particularly uncommon in infants. We present the case of a previously healthy 7-month-old male infant with mediastinal MRT. The patient initially presented with left eyelid ptosis and was otherwise asymptomatic. Initial investigations, including brain MRI, yielded unremarkable results, and the infant was discharged with vitamin B supplements. However, he was readmitted a week later with prolonged fever, poor feeding, diarrhea, and respiratory distress. Despite an initial diagnosis of bronchiolitis/viral respiratory tract infection, the patient's condition rapidly deteriorated. Subsequent evaluation revealed mediastinal MRT as the underlying cause. This case underscores the diagnostic challenges associated with mediastinal MRT in infants and highlights the importance of considering rare neoplastic etiologies in atypical clinical presentations.

Evaluation of acceptance, attitude, and knowledge towards artificial intelligence and its application from the point of view of physicians and nurses: A provincial survey study in Iran: A cross-sectional descriptive-analytical study.

Background and Aims: The prospect of using artificial intelligence (AI) in healthcare is bright and promising, and its use can have a significant impact on cost reduction and decrease the possibility of error and negligence among healthcare workers. This study aims to investigate the level of knowledge, attitude, and acceptance among Iranian physicians and nurses. Methods: This cross-sectional descriptive-analytical study was conducted in eight public university hospitals located in Tehran on 400 physicians and nurses. To conduct the study, convenient sampling was used with the help of researcher-made questionnaires. Statistical analysis was done by SPSS 21 The mean and standard deviation and Chi-square and Fisher's exact tests were used. Results: In this study, the level of knowledge among the research subjects was average (14.66 ± 4.53), the level of their attitude toward AI was relatively favorable (47.81 ± 6.74), and their level of acceptance of AI was average (103.19 ± 13.70). Moreover, from the participant's perspective, AI in medicine is most widely used in increasing the accuracy of diagnostic tests (86.5%), identifying drug interactions (82.75%), and helping to analyze medical tests and imaging (80%). There was a statistically significant relationship between the variable of acceptance of AI and the participant's level of education (p = 0.028), participation in an AI training course (p = 0.022), and the hospital department where they worked (p < 0.001). Conclusion: In this study, both the knowledge and the acceptance of the participants towards AI were proved to be at an average level and the attitude towards AI was relatively favorable, which is in contrast with the very rapid and inevitable expansion of AI. Although our participants were aware of the growing use of AI in medicine, they had a cautious attitude toward this.

Clinical characteristics and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 infection in Iran: A multicenter study.

OBJECTIVES: This study aimed to assess the clinical characteristics, treatment and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 in five different geographical regions of Iran. METHODS: In this multicenter observational study, patients <21 years were included between March 2020 and October 2021. By Disease Control and Prevention (CDC) checklist, demographic characteristics, comorbidities, clinical signs and symptoms, laboratory and radiology findings, and treatment were collected. Statistical analysis was using Chi-square and t-test in STATA14. RESULTS: In total 225 patients with median age of 55 (26-96) months were included that 59.56% boys. 57.33% were admitted to the PICU with a median of 7 days (4-10). 95.56% of patients were discharged with recovery and the rest died. All of the patients in our study were included based on the MIS-C criteria. However, some patients had Kawasaki symptoms, so we compared the clinical and epidemiological characteristics of the two groups. Conjunctival injection, cervical lymphadenopathy>1.5 cm diameter, and strawberry tongue in Kawasaki-like MIS-C patients were higher than of MIS-C patients, and this difference was significant(p<0.001). The most common comorbidity was obesity (24.86%). Most patients tested for COVID-19 and about 60% of the patients had a positive test by serology or reverse transcription-polymerase chain reaction (RT-PCR). Gastrointestinal (88.89%) and hematologic signs (84.44%) were most common. Most drugs used in patients were IVIG and steroids. 88.07% and 61.29% of the patients had at least one problem in echocardiography and lung CT, respectively. CONCLUSIONS: The best outcome was seen in patients who were treated with both IVIG and steroids on the first days of admission. Myocarditis was common in two groups of patients. According to most patients had echocardiography abnormal, screening of heart function is recommended for patients.

Assessing Safety Status of Pediatric Intensive Care Units of Tehran, Iran according to the World Health Organization's Safety Standards.

Introduction: Given that children in pediatric intensive care units (PICUs) are more vulnerable to safety risks, health care officials are required to identify the weaknesses and strengths of care and ensure the safety of these children. In this study, the safety status in PICUs of selected educational children's hospitals in Tehran, Iran, was examined and compared with standards proposed by the World Health Organization (WHO). Methods: In this descriptive study, the performance of nurses with a bachelor's degree or higher and minimum work experience of six months in the PICU was examined. The study environment included four selected educational hospitals located in Tehran, Iran. Data collection tools were eight safety observation checklists based on the safety standards of WHO. Data collection took five months and the nurses' performance was categorized into three groups of undesirable, relatively desirable, and desirable. The data were analyzed using SPSS software version 13, descriptive statistics, and regression analysis. Results: Consistency of nursing care for the safety of hospitalized children was found undesirable in hand hygiene in accordance with the WHO standards. Nurses' performance was relatively desirable in the fields of being more cautious about drugs with similar names or spelling to avoid medication errors, communication during patient hand-over, and performance of correct procedure at correct body site. Regarding other fields, the consistency was at a desirable level. Conclusion: Children's safety in the PICUs is not desirable in terms of observing health codes and there is a long way to go to meet the international standards.

Association of lower vitamin a levels in neonates and their mothers with increased risk of neonatal late-onset sepsis: A case-control study.

BACKGROUND: In developing countries, neonatal sepsis is one of the major causes of mortality and morbidity. Vitamin A deficiency also affects the immune system severely and is associated with various neonatal infections. We aimed to compare maternal and neonatal vitamin A levels among neonates with and without late-onset sepsis. MATERIAL AND METHODS: 40 eligible infants were entered into this case-control study according to inclusion criteria. The case group included 20 term or near-term infants who had late-onset neonatal sepsis from three to seven days of life. The control group consisted of 20 term or near-term infants who were icteric hospitalized neonates without sepsis. Demographic, clinical and paraclinical features, as well as neonatal and maternal vitamin A levels, were compared between the two groups. RESULTS: The average gestational age of the neonates was 37.1 ± 1.2, ranging from 35 to 39 days. There was a significant difference between the septic and non-septic groups in terms of white blood cell and neutrophil count, C-reactive protein, and neonatal and maternal vitamin A levels. A Spearman correlation analysis showed a significant direct correlation among maternal and neonatal vitamin A levels (correlation coefficient = 0.507; P-value = 0.001). Multivariate regression analysis showed that neonates' vitamin A level had a significant direct association with sepsis (OR: 0.541; P-value=0.017). CONCLUSION: Our findings demonstrated the association of lower vitamin A levels in neonates and their mothers with an increased risk of late-onset sepsis, which emphasizes the importance of the consideration of vitamin A level evaluation and its appropriate neonatal and maternal supplementation.

A review of peripherally inserted central catheters and various types of vascular access in very small children and pediatric patients and their potential complications.

Accessing the veins for blood delivery, sampling or nutrition is a critical factor in the process of care and management of pediatric patients. In this regard, the peripherally inserted central catheter (PICC) is one of the main alternatives which could be applied effectively as traditional central venous devices in neonates and adults. Due to their essential role in providing safe central venous entry, PICCs could be applied extensively in patients who are critically ill. The main aims of the present study are to review approximately all relevant publications concerning PICC procedures, any possible complications, and the most appropriate decision for preventing these complications due to their high mortality rate. We carried out a comprehensive search on PubMed, HubMed, EMBASE, MEDLINE, Science Direct, Scopus, MEDLINE, and EMBASE databases for identifying the most relevant publications related to potential complications following the application and insertion of PICCs in hospitalized children and infants. Through appropriate care of catheters, the rate of possible infectious, mechanical and thrombotic complications would decrease considerably compared to those patients who received traditional central venous catheters. However, the process of vascular access in neonatal and children is very challenging. Any delay or denying treatment due to the lack of vascular access is intolerable. In this regard, anesthesiologists must achieve extra knowledge of various vascular devices.

Cardiac abnormalities due to multisystem inflammatory syndrome temporally associated with Covid-19 among children: A systematic review and meta-analysis.

BACKGROUND: Cardiac defects due to multisystem inflammatory syndrome in children (MIS-C) have been abundantly reported leading high morbidity among children affected by Covid-19. We aimed to systematically assess the incidence of such cardiac abnormalities due to MIS-C in children suffering Covid-19. METHODS: The manuscript databases including Medline, Web of knowledge, Google scholar, Scopus, and Cochrane were deeply searched by the two blinded investigators for all eligible studies based on the relevant keywords. The risk of bias for each study was assessed according to QUADAS-2 tool. Statistical analysis was performed using the Comprehensive Meta Analysis (CMA) software. RESULTS: In final, 21 articles (including 916 children) were eligible for the final analysis that all yielded good quality and none of the citation was determined to have high risk of bias. Considering studies focusing different cardiac abnormalities related to MIS-C yielded a pooled prevalence of 38.0% for significant left ventricular dysfunction, 20.0% for coronary aneurism or dilatation, 28.1% for ECG abnormalities or cardiac arrhythmias, 33.3% for raised serum troponin level and 43.6% for raised proBNP/BNP level. CONCLUSION: Although cardiac abnormalities among children suffering Covid-19 are uncommon, in the context of the MIS-C can be common and therefore potentially serious and life threatening.

A critical analysis of Iran health system reform plan.

INTRODUCTION: Iran's Health System Reform Plan (HSRP) were initiated in public and hospitals affiliated to Medical Sciences Universities in June 2015. The purpose of the present paper is to provide a critical analyse of the HSRP and its outcomes. METHODS: The study was carried out as a review critical analyse in 2019. The pertinent articles were searched for in Science Direct, PubMed, Ovid, and Google Scholar using keywords "health sector," "reform plan," "health system reform," "health services," "health care system," and "Iran." Published articles in scientific national and international journals in Persian and English language, of which the full-texts were available, were entered into the study. Finally, from a total of 75 articles obtained, 45 studies were carefully reviewed. RESULTS: Several factors, which impact in the success of Iran's HSRP such as social-economic and political outlooks, lack of official information and a comprehensive management system, in addition to failure to extend continuous performance control, economic sanctions against Iran. Other factors are limitations on financial transactions between Iran and the rest of the world due to the sanctions, relying merely on a few instructions, and negligence of the required infrastructures. In terms of advantages of the plan, relative decrease in patient's share in medical expenses, improvement of emergency wards, and relative decrease in the rate of C-section operations are notable. CONCLUSION: Better implementation of Iran's HSRP entails the provision of resources and facilities such as stable and adequate resources, proper management of available resources, payment mechanisms reform, attracting, and facilitating private sector's participation.

Potentiality of PARAFAC approaches for simultaneous determination of N-acetylcysteine and acetaminophen based on the second-order data obtained from differential pulse voltammetry.

N-acetylcysteine (N-AC) has widespread application such as pharmaceutical drug and nutritional supplement. Its adverse effects are rash, urticaria, and itchiness and large doses of N-AC could potentially cause damage to the heart and lungs. Therefore, in this work, a sensitive voltammetric sensor based on a carbon paste electrode modified with silica nano particles (i.e. Mobil Composition of Matter (No. 41) modified with Boron Trifluoride or BF3@MCM-41) with a combination of 4,4'-dihydroxybiphenyl (DHB) (BF3@MCM-41/DHB/CPE) was designed for determination of N-AC. The electrochemical oxidation of N-AC was examined using various techniques such as cyclic voltammetry (CV), chronoamperometry and differential pulse voltammetry (DPV). Under the optimum conditions, some parameters such as electron transfer coefficient (α) and heterogeneous rate constant (ks) were estimated for N-AC. Due to the use of N-AC for the treatment of acetaminophen (AC) overdose, the application of modified electrode was investigated for the simultaneous determination of N-AC and AC in blood serum and tablet samples. Since, the signals of these species overlap and due to the presence of interfering species in blood samples, the simultaneous determination of mentioned species is difficult or impossible. To overcome this challenge, parallel factor analysis (PARAFAC) was used for the analysis of the complex matrices to obtain the spectral profile of each component and interference. To achieve this goal, electrochemical second-order data were generated using a simple change in pulse height of differential pulse voltammetry. The results of the presently proposed strategy for the real samples analysis are similar to those obtained with HPLC. Thus, the proposed method has acceptable performance for simultaneous determination of the two species in real samples.

Effect of Cultural Themes on Forming Cotard's Syndrome: Reporting a Case of Cotard's Syndrome with Depersonalization and Out of Body Experience Symptoms.

OBJECTIVE: Cotard's syndrome is a rare psychiatric syndrome. Its core symptom is nihilistic ideation or delusion. CASE REPORT: A female patient with Cotard's syndrome symptoms associated with out of body experience and depersonalization, and complicated grief was referred for evaluation. She believed that she was killed by a creature named "Aal" in the Persian folklore Conclusions: Cultural and superstitious beliefs could affect the forming of the complex constellation of the patient's symptoms including Cotard's syndrome symptoms. The resolution of symptoms might be achieved step by step. DECLARATION OF INTEREST: None.

The Correlation between Emotional Intelligence and Instable Personality in Substance Abusers.

BACKGROUND: Substance dependence has recently turned into one of the most important social problems. Clinical findings have shown personality traits, social relations, attitudes and values, along with emotional intelligence factors such as emotions, feelings, emotions management, challenging with problems, problem solving, tolerating psychological pressure, impulse control, self esteem and interpersonal relations, to affect substance dependence. Consequently, understanding the meaning and developing tools for assessment of emotional intelligence are significantly vital in human psychological health. This study aimed to investigate the relation between emotional intelligence and instable personality in substance abusers. METHODS: The present correlational study selected 80 male addicts through available sampling. The subjects referred to the Therapeutic Community Center and Kimia, Yas, and Aban Clinics in Yazd, Iran. Their emotional intelligence and personality were evaluated by BarOn questionnaire and Eysenck personality questionnaire (EPQ) for adults, respectively. Pearson's correlation coefficient was used to assess the correlations between different factors. FINDINGS: There was a negative significant correlation (P = 0.050) between emotional intelligence and instable personality in substance abusers. Problem solving and optimism (P = 0.001), interpersonal relation (P = 0.010), self esteem (P = 0.013), and realities (P = 0.017) had significant effects on instable personality. CONCLUSION: Based on our findings, emotional intelligence was significantly correlated with instable personality in substance abusers. However, using more accurate tools in order to assess all aspects of personality can give better results.

Afferent input modulates the chronic hypercapnia-induced increase in respiratory-related central pH/CO2 chemosensitivity in the cane toad (Bufo marinus).

The goal of this study was to examine the role of respiratory-related afferent input on the chronic hypercapnia (CHC)-induced increase in central respiratory-related pH/CO2 chemosensitivity in cane toads (Bufo marinus). Toads were exposed to CHC (3.5% CO2) for 10 days, following which in vitro brainstem-spinal cord preparations were used to assess central respiratory-related pH/CO2 chemosensitivity. Motor output from the vagus nerve root was used as an index of breathing (fictive breathing). Olfactory denervation (OD), prior to exposure to CHC, was used to remove the influence of CO2-sensitive olfactory chemoreceptors, which inhibit breathing. Exposure to chronic hyperoxic hypercapnia (CHH) was used to reduce the level of arterial chemoreceptor input compared with CHC alone. In vivo experiments examined the effects of CHC, CHH and OD on the acute hypercapnic ventilatory response of intact animals. In vitro, a reduction in artifical cerebral spinal fluid (aCSF) pH increased fictive breathing in preparations taken from control and CHC animals. CHC caused an increase in fictive breathing compared with controls. OD and CHH abolished the CHC-induced augmentation of fictive breathing. In vivo, CHC did not cause an augmentation of the acute hypercapnic ventilatory response. CHH reduced the in vivo acute hypercapnic ventilatory response compared with animals exposed to CHC. In vivo, OD reduced breathing frequency and increased breath amplitude in both control and CHC animals. The results suggest that afferent input from olfactory and arterial chemoreceptors, during CHC, is involved in triggering the CHC-induced increase in central respiratory-related pH/CO2 chemosensitivity.