Software-defined traffic light preemption for faster emergency medical service response in smart cities.

Proper management of rescue operations following an accident is one of the most fundamental challenges faced by today's smart cities. Taking advantage of vehicular communications, in this paper we propose novel mechanisms for the acceleration of the rescue operation resulting in a reduction in fatalities in accidents. We propose a Software-Defined Traffic Light Preemption (SD-TLP) mechanism that enables Emergency Medical Vehicles (EMVs) to travel along the rescue route with minimal interruptions. The SD-TLP makes preemption decisions based on global knowledge of the traffic conditions in the city. We also propose mechanisms for the selection of the nearest emergency center and fast discharge of the route of EMVs. Furthermore, depending on the dynamic traffic conditions on the streets at the time of the accident, an appropriate rescue route is selected for the EMV before its departure. The proposed approach is evaluated using the OMNET++ and SUMO tools over part of the Megacity of Tabriz, Iran. The simulation results demonstrate that the method can reduce the average rescue time significantly. The proposed approach keeps the resulting disruption in city traffic acceptably low while trying to shorten the rescue time as much as possible.

Chronic constipation: A review of literature.

BACKGROUND: Chronic constipation is described as a common complication determined by difficult and/or rare passage of stool or both. The difference in definition of constipation has led to a wide range of reported prevalence (i.e., between 1% and 80%). Various factors are involved in the pathogenesis of the disease, including type of diet, genetic predisposition, colonic motility, absorption, social economic status, daily behaviors, and biological and pharmaceutical factors. Diagnostic and therapeutic options play a key role in the treatment of chronic constipation. There are still debates about the timing of these diagnostic and therapeutic algorithms. METHODS: A systematic and comprehensive search will be performed using MEDLINE, PubMed, EMBASE, AMED, the Cochrane Library and Google Scholar. Better understanding of the pathophysiology of chronic constipation and efficacy of pharmacological agent can help physicians for treating and managing symptoms.In this study, some of the old and new therapies in the treatment of chronic constipation have been studied based on the controlled studies and strong evidence. We are trying to address some of the controversial issues to manage the disease and to provide appropriate diagnostic options in an efficient and cost-effective way. RESULTS: The results of this systematic review will be published in a peer-reviewed journal. CONCLUSION: To our knowledge, our study will provide an overall estimate of chronic constipation to assess controversial issues, available diagnostic and therapeutic strategies of chronic constipation. ETHICS AND DISSEMINATION: Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care.

Association Between Anxiety and Depression With Dialysis Adequacy in Patients on Maintenance Hemodialysis.

BACKGROUND: Depression and anxiety are common among hemodialysis patients and affect their treatment outcomes. Dialysis adequacy also affects the hemodialysis patients' survival rates. OBJECTIVES: This study aimed to evaluate the correlation between anxiety and depression with dialysis adequacy. PATIENTS AND METHODS: In this cross-sectional study, 127 hemodialysis patients (73 males, 57.5%) with the mean age of 55.7 ± 17.5 were enrolled. Demographic and recent laboratory data were collected using self-administered questionnaires and by reviewing medical records. Dialysis adequacy measures including the Kt/V and urea reduction rate (URR) were calculated using standard formulas. The Hospital Anxiety and Depression Scale (HADS) was used to diagnose depression and anxiety. Independent sample t-test and Chi-square test were used to compare the values in different groups. Pearson correlations and linear regression were used to analyze the data using SPSS version 21. RESULTS: The prevalence rates of depression and anxiety (HADS score ≥ 8) were 31.5% and 41.7%, respectively. The prevalence of both conditions was significantly higher in women than in men (P < 0.05). The mean values of Kt/V and URR were not different in patients with and without depression or anxiety. The anxiety scores were correlated with age (P = 0.007, r = -0.24) and parathyroid hormone (P = 0.04, r = -0.19). Younger age and lower parathyroid hormone were the only factors that predicted higher scores of anxiety in linear regression. The Kt/V or URR were not significantly correlated with depression and anxiety scores. CONCLUSIONS: Depression and anxiety are common among hemodialysis patients. There are no statistically significant correlation between depression and anxiety and dialysis adequacy.

Renal artery stenosis in kidney transplants: assessment of the risk factors.

BACKGROUND: Transplant renal artery stenosis (TRAS) is an important cause of hypertension and renal allograft dysfunction occurring in kidney transplant recipients. However, conflicting predisposing risk factors for TRAS have been reported in the literature. OBJECTIVE: The aim of the present study was to assess the potential correlation between possible risk factors and TRAS in a group of living donor renal transplant recipients 1 year after the renal transplantation. METHODS: We evaluated the presence of renal artery stenosis in 16 recipients who presented with refractory hypertension and/or allograft dysfunction 1 year after renal transplantation. Screening for TRAS was made by magnetic resonance angiography and diagnosis was confirmed by conventional renal angiography. Age, gender, history of acute rejection, plasma lipid profile, serum creatinine, blood urea nitrogen, serum uric acid, calcium phosphate (CaPO4) product, alkaline phosphatase, fasting blood sugar, hemoglobin, and albumin were compared between the TRAS and non-TRAS groups. RESULTS: Of 16 kidney transplant recipients, TRAS was diagnosed in three patients (two men and one woman). High levels of calcium, phosphorous, CaPO4 product, and low-density lipoprotein (LDL) cholesterol were significantly correlated with the risk of TRAS 1 year after renal transplantation (P < 0.05). Serum level of uric acid tended to have a significant correlation (P = 0.051). CONCLUSION: Correlation between high CaPO4 product, LDL cholesterol, and perhaps uric acid and TRAS in living donor renal transplant recipients 1 year after renal transplantation might suggest the importance of early detection and tight control of these potential risk factors.

Impact of cardiovascular risk factors on the outcome of renal transplantation.

Cardiovascular diseases are common in renal transplant recipients and renal insufficiency has been shown to be a risk factor for cardiovascular disease. Some studies have reported that cardiovascular risk factors may contribute to the outcome of renal transplantation. This study was performed to determine the impact of cardiovascular risk factors on the outcome of renal transplantation in Iranian subjects. This is a retrospective, observational study including patients of 20-85 years of age who had undergone renal transplantation. Parameters documented and analyzed included demographics, cardiovascular risk factors, past medical history, date of last transplantation, the outcome of transplant, last measured serum creatinine, cause of graft failure, rejection, and death. A total of 192 patients were analyzed including 152 in the case group (with identifiable cardiovascular risk factors) and 40 controls (transplant recipients without identifiable risk factors). The mean serum creatinine in the case and control groups were 1.33 +/- 0.13 and 1.29 +/- 0.36 mg/dL respectively (P = 0.493). Response to transplantation was categorized based on a report from the World Health Organization. Complete response to grafting occurred in the control group more than the case group (P = 0.009), while frequency of partial response to grafting was higher in the case group (0.008). A history of chronic obstructive pulmonary diseases (COPD) could significantly predict the outcome of grafting (P = 0.008) as could the occurrence of renal failure (P = 0.022). Results were consistently reproduced using multivariate cumulative log it model. Our study indicates that the measured cardiovascular risk factors do not significantly influence the outcome of renal transplantation.

C- Reactive protein, cardiac troponin T and low albumin are predictors of mortality in hemodialysis patients.

Overall and cardiovascular mortality are significantly higher in hemodialysis patients with elevated C-reactive protein (CRP). The aim of study was to determine whether CRP, low albumin and troponin are markers of overall and cardiovascular mortality in hemodialysis patients. 138 stable hemodialysis patients were divided into 2 groups n= 66 patients with coronary disease equivalent (known coronary or peripheral vascular disease or diabetes mellitus) and n= 72 patients without it. The two groups were then stratified by biomarkers [cardiac troponin T and albumin and highly sensitive CRP (hs-CRP)] and followed for 30 months. The primary outcome was all causes mortality. Patients with coronary disease equivalents had 3.5 fold greater annual mortality compared to controls (24%% vs 6.9%, P value = 0.005). Elevated troponin T had a further increase in the risk for death while hs-CRP and low albumin were not associated with risk of death In conclusion, circulating cardiac troponin-T was associated with poor prognosis especially in hemodialysis patients with coronary risk factors.

Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients.

Hemodialysis (HD) patients suffer from chronic inflammations which make them at increased risk of cardiovascular diseases. The purpose of this study was to see if there is a significant association between inflammatory factors such as ferritin and C-reactive protein (CRP) as well as troponin T in patients on HD. We assessed these serum factors as well as other known cardiac risk factors in 53 patients on HD. The serum ferritin and CRP levels were measured by chemiluminescence's immune assay while troponin T levels were measured by electrochemist luminescence immune assay. We found that serum concentrations of CRP and ferritin were not significantly higher in patients on HD with known cardiac risk factors (compared with the control group) (p< 0.05). However, the serum troponin T levels in HD patients with cardiovascular risk factors were significantly higher than the control group. Our study suggests that elevated serum troponin T levels can play an important role as a predictor of cardiovascular disease in HD patients. Also, inflammatory factors such as CRP and ferritin may be influenced by chronic inflammation or nutritional status of these patients.

Cyclosporine in the treatment of membranoproliferative glomerulonephritis.

BACKGROUND: Therapeutic approach to patients with idiopathic membranoproliferative glomerulonephritis is still controversial. Because it is more common in developing countries, the studies about it are limited. METHODS: We used cyclosporine to treat 18 patients with membranoproliferative glomerulonephritis who were resistant to other treatment protocols such as using aspirin, dipyridamole, or steroids. All patients were treated with cyclosporine plus low-dose prednisone and were followed for an average 108 weeks. RESULTS: Partial or complete remission of proteinuria occurred in 94% of the patients (P<0.01). Relapse occurred in one (14.2%) of remitters after discontinuation of the drug. But the remainder stayed in remission to the end of the observation period. There was a 507% decrease in the baseline creatinine clearance in one patient (5.5%). CONCLUSION: These results suggest that cyclosporine may be an effective therapeutic agent in the treatment of resistant idiopathic membranoproliferative glomerulonephritis. Although the response is appeared later than other types of glomerulonephritis, but a long-term decrease in proteinuria and preservation of filtration function were observed in a significant proportion of the treated patients.

Paget's disease of bone in a patient on hemodialysis.

Paget's disease is a disorder of bone remodeling. Its occurrence in hemodialysis patients is very rare. Here, we report a case of Paget's disease in a 77-year-old patient on hemodialysis who presented with elevated serum level of alkaline phosphatase without any clinical or laboratory findings of secondary hyperparathyroidism. To our best knowledge, this is the first reported case of Paget's disease in a patient with end-stage renal disease from Iran.