emergency medical center مرکز اورژانس پزشکی
in a natural disaster such as an earthquake,very often due to the extensive number of severe injuries,demands for blood units sharply increase in emergency hospitals.regarding such a problem,we propose a new robust two-stage multi-period stochastic model for the blood supply network design with the consideration of a possible natural disaster.the demand for blood units from different types and their derivatives including plasma and platelets are uncertain variables.as a novel contribution,the possibility of transfusion of one blood type as well as its derivatives to other types based on the medical requirements is considered in the optimization model.the pertinent network consists of three layers including the donated areas,the collection blood centers,and the transfusion blood center,which is usually a governmental organization.the model is also constructed for considering a likely earthquake in tehran (the capital of islamic republic of iran) using a professional report prepared in the year 1999 and also updated in a next research work.the scenarios for the demands of blood units and their derivatives are generated based on these reports.the mathematical model is implemented and assessed in a proper way using the simulation method.© 2017 springer science+business media new york
studies show that by the course of time,the number of natural disasters such as earthquakes is increasing.therefore,developing a model for locating distribution centers and relief goods distribution systems in disaster times,along with appropriately locating health centers with the ease of access for transferring the casualties and saving their lives,is among the most essential concerns in relief logistics.considering these two subjects,simultaneously,results in an increase in the quality of service in disaster zones.in this study,a multi-objective programming model is developed for locating relief goods distribution centers and health centers along with distributing relief goods and transferring the casualties to health centers,with pre/post-disaster budget constraints for goods and casualties logistics.for a better modelling of the reality,the uncertainties in demand,supply,and cost parameters are included in the model.also,facility failure (e.g.relief distribution centers,health centers,hospitals and supply points failure) due to earthquakes is considered.the proposed model maximizes the response level to medical needs of the casualties,while targeting the justly distribution of relief goods and minimizing the total costs of preparedness and response phases.in order to handle the uncertainties,the robust optimization approach is utilized.the model is solved with ε – constraint method.for the large sized form,the mogasa algorithm is proposed,and the results are compared to those of the nsgaii algorithm.then the validity and efficiency of the proposed algorithm is explored based on the results of both the proposed and exact methods.© 2017 elsevier ltd
background: saddle nose deformities mostly result from trauma.most reports of saddle nose correction after trauma relate to isolated fractures,but in this article the experience of the authors is presented in relation to bone grafting for the correction of the saddle nose in multiple facial fracture patients.objectives: the current study aimed to report the results of a protocol for choosing the source of bone graft for dorsal nasal bone grafting in acute trauma patients with multiple facial fractures.patients and methods: in a retrospective study,archived files of maxillofacial trauma patients who were treated between 2005 and 2012 at mashhad emdad hospital (a level one trauma center) were reviewed.cases were selected in which a traumatic saddle nose deformity concomitant with other facial fractures had been corrected with dorsal nasal bone grafting.the donor site,type of fixation,access to the dorsum of the nose,associated facial fractures,shape of the graft (cantilever or l-shaped),and plane of dissection in the dorsum of the nose (subperiosteal or subcutaneous) were assessed.results: there were 11 patients treated using this method.the male-to-female ratio was 7:5.one miniscrew with the lag technique was the preferred method for the fixation of the dorsal nasal bone graft.splitcalvarial bone graft was the mostcommonly used type of bone graft.an open rhinoplasty approach and maxillary degloving were two commonly used incisions,and the most commonly associated fractures were maxillary lefort fractures.the cantilever design was used in eight patients for the correction of the saddle nose deformity,and in four patients the bone graft was inserted into the nose in the subcutaneous plane.conclusions: saddle nose reconstruction with bone graft in multiple facial fracture patients is a predictable method if surgical accesses to the region are carefully designed,considering the accompanying fractures.© 2016,iranian red crescent medical journal.
background: the prevalence of hypertension (htn) in developing countries might have a different pattern in different countries.objectives: this study aimed at investigating the current pattern of htn and evaluating its relationship with health complaints in elderly iranian individuals in 2012.methods: this cross sectional study used multistage sampling to investigate 1 350 iranian elderly subjects (≥ 60 years) living in the community.those elderly,who had a systolic blood pressure (sbp) ≥ 140 mmhg and/or diastolic blood pressure (dbp) ≥ 90 mmhg and/or those who used antihypertensive drugs during the previous two weeks,were considered as htn.a face-to-face interview was performed using a structured questionnaire,including demographic factors,awareness,treatment and control of htn,and health complaints for each individual.chi-square test and multiple logistic regression analyses were applied to detect the most important variables related to htn.results: hypertension was seen in 48.5% of individuals.awareness,treatment,and control of htnwere seen in 40.7%,82.5%,and 30% of individuals,respectively.elderly individuals with htn had significantly more experienced visual disturbances (p = 0.03),fecal or urinary incontinence (p = 0.006),nocturia (p = 0.002),attacks of shortness of breath (p = 0.004),and hyperlipidaemia (p < 0.001).after adjusting for potential confounders such as ethnicity,nocturia (or,1.34;ci 95%,1.02-1.75) and hyperlipidemia (or,1.94;95% ci,1.5-2.51) remained significantly relevant to htn.conclusions: the prevalence of htn was lower in elderly community-living iranians than developed countries,yet,was still considerable.nocturia and hyperlipidemia were the most common health complaints in iranian elderly with htn.© 2017,iranian red crescent medical journal.
objectives: the aim of this study was to evaluate the effect of fish oil supplementation on antenatal and postpartum depression score.methods: this was a randomized,triple-blind,placebo-controlled trial.we enrolled 150 eligible pregnant women with edinburgh postnatal depression scale (epds) score of less than 20,aged 18 to 35 from feburary 2014 to april 2015 in tabriz,iran.participants were randomly assigned to receive either 1000 mg of fish oil supplements or placebo from 16-20 weeks of gestation to one month after giving birth.participants completed the epds at baseline,26-30 weeks,35-37 weeks,and 30-45 days after birth.primary outcome measures were the mean depression score at 26-30 weeks,35-37 weeks,and postpartum period.the statistical analysis was intent-to-treat.results: a total of 150 females were included,and no one was lost to follow up.there were significant differences between the two groups in the mean score of depression only at 35-37 (adjusted mean difference =-1.4;[95% ci-2.6 to-0.25]).the mean score of depression during pregnancy and postpartum period significantly decreased within the fish oil group (p < 0.05).there were no significant differences between the two groups in terms of the baseline docosahexaenoic acid (dha) and eicosapentaneoic acid (epa) serum levels.conclusions: fish oil supplements significantly decreased the mean score of epds at weeks 35 to 37.it seems that females may benefit from daily fish oil supplements during pregnancy especially in countries with low intake of fish yet further studies are needed to confirm these results.© 2016,iranian red crescent medical journal.