The objective of this study was to determine the optimum replacement policy for Holstein dairy herds in Iran using a dynamic programming model. Cows were described in terms of state variables that included milk production class, parity, pregnancy status, and month in milk with a 1-mo stage length. The objective function maximized the net present value of cows over a 15-yr planning horizon. Markov simulation was used to estimate expected herd dynamics under the optimal decision plan determined by dynamic programming. Stochastic elements included probabilities of pregnancy and abortion, production level, and involuntary culling. The optimum annual culling rate was estimated to be 31.4%, and cows had an expected herd life (time from first calving until culling) of 3.18 yr. High replacement cost and low carcass value resulted in only 2.87% voluntary culling (i.e., optimal model-based replacement). Assuming a heat detection rate of 0.4, cows averaged 2.8 services per lactation under the optimal policy. Sensitivity analyses were carried out to evaluate the effect of milk price, herd-average production, feed cost, heifer price, and carcass value on optimum replacement decisions. Herd-average production, replacement cost, and risk of involuntary culling were important factors affecting the optimal culling policy. Changes in the price of feed, calves, and milk and the probability of pregnancy had no considerable effect on the optimal policy considering the market situation in Iran during 2008.

In patients on maintenance hemodialysis several factors reduce the body stored carnitine which could lead to dyslipidemia, anemia, and general health in these patients. We evaluated the effect of oral L-carnitine supplementation on lipid profiles, anemia, and quality of life (QOL) in hemodialysis patients. In a randomized, double-blinded, placebo-controlled trial, end-stage renal disease (ESRD) patients on hemodialysis received either L-carnitine 1 g/d (n = 24) or placebo (27 patients) for 16 weeks. At the end of the study, there was a significant decrease in triglyceride (−31.1 ± 38.7 mg/dL, P = 0.001) and a significant increase in HDL (3.7 ± 2.8 mg/dL, P < 0.001) levels in the carnitine group. Decrease in total cholesterol (−6.6 ± 16.0 mg/dL, P = 0.075) and increase in hemoglobin (0.7 ± 1.7 g/dL, P = 0.081) concentrations in the carnitine group were not significant. There was no statistically significant changes in LDL in any group (P > 0.05). Erythropoietin dose was significantly decreased in both the carnitine (−4750 ± 5772 mg, P = 0.001) and the placebo group (−2000 ± 4296 mg, P < 0.05). No improvement was observed in QOL scores of two groups. In ESRD patients under maintenance hemodialysis, oral L-carnitine supplementation may reduce triglyceride and cholesterol and increase HDL and hemoglobin and subsequently reduce needed erythropoietin dose without effect on QOL.

Pituitary germinomas are difficult to be differentiated from lymphocytic hypophysitis due to similar clinical, radiological and even histological findings. However, it is of great importance to make the distinction between them because of different therapeutic approaches of the two diseases. We report a case of neurohypophysial germinoma who initially was misdiagnosed as lymphocytic hypophysitis. The patient was a 26-year-old man who first presented with central diabetes insipidus and subsequent pan-hypopituitarism. Magnetic resonance imaging (MRI) of the pituitary which first had shown mild pituitary enlargement, revealed a pituitary mass of unusual feature after 1 year. Pathological diagnosis of the lesion, biopsied through trans-sphenoidal route, was lymphocytic hypophysitis. Corticosteroid was initiated for him. Despite, intensive treatment clinical symptoms worsened and the patient developed visual field defect. Follow-up MRI revealed enlargement of the pituitary mass with suprasellar extension and involvement of optic chiasm. Surgical resection of the mass was performed, and the second histological examination confirmed the diagnosis of germinoma. Subsequently, the patient underwent radiotherapy, and complete remission was achieved; however, pan-hypopituitarism persisted. In conclusion, the possibility of neurohypophyseal germinoma should be considered in patients with the diagnosis of lymphocytic hypophysitis who do not respond to corticosteroid therapy.

Background: Fear of hypoglycemia is a medical emergency which leads to disrupt individuals' normal lives. Peers support is a hopeful approach to improve diabetes self-care behaviors. This study was conducted to assess the effect of peers support on the fear of hypoglycemia in patients with type 1 diabetes. Materials and Methods: This randomized clinical trial study was performed among 60 patients with type 1 diabetes in Qazvin city from September 2019 to October 2020. Patients were assigned to control and intervention groups using a random method. The data collection tools included demographic characteristics and a standard questionnaire for Hypoglycemia Fear Survey (HFS). Patients in the intervention group were trained by skilled peers for 2 months, but those of the control group only received routine hospital training. The data were analyzed by SPSS version 16 and paired and independent t -test. Results: The scores of the fear of hypoglycemia in diabetic patients in the two groups had no significant statistical difference before intervention (t 53 = 0.93, p = 0.94). But after the intervention, the independent t -test showed that there was a significant difference between the scores of the fear of hypoglycemia in both groups (t 53 = -2.13, p = 0.03). Conclusions: Considering the results of the current study, peer support for diabetic patients is an effective way to reduce the fear of hypoglycemia. Therefore, it is recommended using this training method to train diabetic patients.

Coronavirus Disease 2019 (COVID-19) is a severe respiratory disease initiated on December 2019. Genome sequence analysis shows that the pathogen is a complex beta-coronavirus RNA, known as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Spontaneous Pneumomediastinum and pneumothorax are rare clinical and radiological conditions associated with COVID-19. This study is case report of pneumomediastinum and subcutaneous emphysema in two patients with COVID-19, while investigating the clinical and paraclinical symptoms and the treatment process of two cases. Finding factors related to the severity of COVID-19 for improving the final outcome in patients is very important.