Journal of Kermanshah University of Medical Sciences
Year:2003 | Volume:6 | Issue:4|Papers Count:12

Background & Objective: During the previous imposed war, Iranian soldiers were exposed to mustard gas and are still suffering from numerous problems such as recurrent infections, respiratory dysfunction, increase in incidence of leukemia and lymphoma as well as increase of Atypic lymphocyte in blood. These may be due to destructive effect of mustard gas on bone marrow and the function of phagocytes. In this study the number and the fuction of monocytes were investigated.Materials & Methods: In this retrospective study peripheral blood samples were collected from 75 chemically wounded patients plus 10 people as control group. CBC, flowcytometric results and other features were used in classifying the patients into three groups of mild, moderate, and severe. The results were evaluated by CD 14 and HLA-DR methods. Variation analysis and Scheffe tests were used in data analysis.Results: The results showed a significant difference of WBC between severe and control group (P<0.05). The percentage of CD14+ and CD14+ /CD16+ cells showed no significant difference among three groups compared to control group (P>0.05). CD14+ /HLA-DR+ cells in level 0.1 , Fprob=0.052 of moderate group compared to control group showed a significant increase but in severe group had a sharp fall.Discussion: It seems that the trend of generating monocytic cells in bone marrow has no problem but their function in getting back to full activity have some problems. The increase of WBC in severe group is probably due to chronic infections and pulmonary traumas. Investigating other immunity cells and their interrelation and studying the effect of microorganisms in such patients on markers incidence can be helpful in clarifying this problem.

Background & Objective: Gallium is an element being used in medical imaging and chemotherapy and proved to be accumulated in the liver. Since no reports have been published on the effects of gallium on hepatic functions (such as bilirubin and aminotransferases), the present study tends to investigate the long-term effects of gallium on hepatic funtions and the involved mechanism.Materials & Methods: The experimental study carried on 35 rats. They were divided into 7groups each containing 5 rats. The first 3 groups group A) received intraperitoneal injections of 5, 10 and 15 mg of gallium per kilogram of body weight for 30 days; while the later 3 other groups (group B) received the same amount of gallium for 60 days; Rats in the control group had physiological saline in the same values. Bilirubin and aminoteransferases in their blood samples were measured.Results: Analysis of the data showed that in the dose of 15 mg/kg for 30 days the activity of AST and ALT was increased 44.66% and 12.38% respectively. Total and direct bilirubin was also increased. In the rats receiving the same dose of gallium for 60 days. Compairing to control group , the levels of AST, ALT and total bilirubin was increased 301%, 594% and 900% respectively from which the difference of total bilirubin was statistically significant. Discussion: Gallium accumulation in hepatocytes and its binding with -SH group on Na- K pump inhibits bilirubin secretion and its transport to biliary ducts. Since bilirubin plays a detergenic role, its accumulation in intramembrane spaces results in the destruction of cellular membrane and the release of aminotransferases into serum. Analysis of data showed 301% increase in AST activity as compared with that of the control group. Continuous administration of gallium not only led to the destruction of cellular and mitocondrial memberanes, but also released alanine aminotransferases into serum. The increase of ALT activity was 594.7% in comparison with the control group. Due to the interruption of bilirubin transport to biliary ducts, its serum level went up dramatically. Data analysis also indicated a 900% increase in bilirubin level which is attributed to the disruption in its transport to biliary ducts.

Background & Objective: Phthalic acid is one of the toxic organic contaminats which can enter the environment through various industries. Biological removal of this pollutant before disposing the wastewater plays an important role for environmental protection and human health. This study is aimed to achieve the efficiency of suspended activated sludge system in biological removal of domestic and industrial wastewater contaminants. The variables of concentration and hydraulic retention time were studied to gain the best allowed volumetric loading time and hydraulic retention time.Materials & Methods: In this descriptive-analytic research 144 effluents and 23 sludge samples were studied. In this system for biological elimination of phthalic acid, four different hydraulic retention times of 6, 12, 24 and 48 hrs were used. The volumes of aeration and setteling were 6 and 3 liters respectively and total COD feed has been adjusted to 1000 mg/l along with Glucose. The concentrations of inlet phthalic acid were 10, 20, 50 and 500 mgl. COD, BOD5 and phthalic acid concentrations (using HPLC- UV with wave length of 210 nm) have been measured in effluent. For analysing the data, variant analysis, Cheffe test and Pearsons coefficient of correalation were used.Results: In all four retention times phthalic acid was removed. The average phthalic acid removal in hydraulic retention times of 6, 12, 24 and 48 hrs with 10-500 mg/l inlet concentration were 87.5±10.5, 97.5±2.6, 99.6±0.3 and 99.8±0.03 percent respectively. The average COD removal were 88.6±11.6, 95.5± 3, 97.4±0.88 and 98±0.5 percent respectively. The rate of phthalic acid in sludge and the inlet phthalic acid viscosity were 100-320 mg/kg. Discussion: This system has the ability to tolerate the phthalic acid in hydraulic retention times with different inlet concentration. The average removal of phthalic acid and COD in 24 and 48 hrs retention times are more stable. There was a meaningful relationship between removal rate of phthalic acid and COD with retention times. There was a complete reversed and meaningful relationship between the increase of inlet phthalic acid concentration and the removal rate of these parameters. If the concentration of inlet phthalic acid is less than 50mg/l., the 12hrs retention time is recommended but for over 50 mg/l, 24 hrs retention time is suggested. Allowed volumetric loading rates for 6, 12 and 24 hrs were 80, 100 and 500 g/m3d. The sludge of this system has high adsorption ability of phthalic acid.

History & Objectives: With respect to the extensive use of local anesthesia, nerve block and considering the local anesthetic effects of meperidine, which has not been used up-to-now, this study was aimed to evaluate the effects of meperidine on lidocaine induced auxillary block, particularly the block length.Materials & Methods: The subjects of this double-blind clinical trial study included 40 ASA class I and II patients between 15 and 56 which were later divided into two homogenous groups of 20, with the approval of the medical Ethic committee. The subjects in lidocaine group received 40 ml of 1% lidocaine and 0.01ml/kg normal saline; While the subjects in the other group received 40 ml lidocaine and 0.01ml/kg equal to 1 mg/kg of meperidine, as an auxillary block solvent, through transarterial technique. The collected data was analyzed by x2, Fisher exact and student-T-tests.Results: Data analysis showed the block length in meperidine group (i.e.238.4±67.04 m) was more than that of lidocaine group (166.7±39.6 m) which was statistically significant (P<0.001). No statistically significant differences was seen in the onset time of block, block integrity and systemic adverse effects such as nausea, vomiting, hypotension, dizziness, arrhytmia and seizure between these groups.Discussion: This study showed administration of meperidine to lidocaine induced auxillary block prolongs the block length significantly without affecting its onset time and producing systemic problems. Hence the application of this method/technique can be useful in prolonged surgical procedures specifically the emergency cases with relatively contraindicated general anesthesia and in post-operative analgesio after minor surgeries.

Background & Objective: The correct scrubbing up is one of the most effective methods in preventing the infection transmisson. The fact is that no specific length of time as a routine scrubbing up has been recommended; but various length of times have been cited. Therefore, this study is aimed to compare the microbial contamination of the operation room's team done in educational and clinical centers of Kermanshah university of Medical Sciences in 1999.Materials & Methods: This is an experimental study which was performed in two phases and on twenty members of the operation room. They were chosen clustered or randomly. After selecting the subjects, the classification of scrubbing length of times has been explained to each of them. Then before washing their hands for the operation, the bacterial samples were taken from their hands. For the next three operations they were asked to do two, four, and six minute scrubbing with at least 18 hours intervals. After each scrubbing up bacterial samples were collected and sent to the lab. The bacterial colonies and the type of microorganisms were numbered and distinguished. In analyzing the findings the descriptive statistics, Kruskal-Wallis and Wilcoxon Signed Ranks tests were used.Results: The results of Kruskal-Wallis test showed no significant differences among these three time methods of scrubbing (p=0/420). The study of Gram Negative Bacilli revealed that the two minute method is not able to destroy these bacilli which are as common hand infections in hospitals. On the other hand, six minute scrub seems too long. There were significant differences among the medians of colony numbers before and after scrubbing up (P<0.005) and the six minute scrubbing up method seems to be longes than four minute one.Discussion: This study showed that the four minute scrubbing up method is the most appropriate method for decreasing the hand contamination and hospital infections. More studies are recommended for finding an appropriate method and effective solution for scrubbing up.

Background and Objectives: Stroke is the second cause of death in Japan and the third one in the U.S.A. Most of the studies done in industrial countries have revealed a decrement in a mortality rate of stroke which can be attributed to the control of risk factors of stroke and the increase in medical health care in such cases. Meanwhile researchers have shown mortality rate of stroke even within the boarders of a single country differes according to the age, ethnic background and sex of the victims as well as geography of their residence. Due to the lack of reliable information about mortality rate of stroke in Iran, the present study was aimed to evaluate the morality rate of stroke victims at Farabi Hospital between 1998 and 2000.Materials & Methods: This retrospective-descriptive study was based on the available records of stroke victims admitted at Farabi Hospital between February 1998 and March 2000. Variables including victims age, sex, type of lesion in computed tomography scan(CTS), level of consciousness, blood sugar at the time of admission as well as their cholestrole level, history of smoking and cardiac disease were closely measured and analyzed.Results: Data analysis showed that from 1679 stroke victims admitted at the hospital in this period, 348 cases died. Mortality rate was 21% with a highest rate in a age group of 65-74. Analysis of CTS indicated 35.5% of victims had hemorragic lesions. 326 victims suffered from hypertension and 13% had hyperglacimia. With respect to the level of consciousness at the time of admission, 104 cases were in light coma, 89 were confused, 69 were in deep coma, and 86 were conscious. 24.7% of victims had a history of smoking.Discussion: Data analysis revealed that the mortality rate at Farabi Hospital was not more than other recorded centers. It also became clear that hemorragic stroke is an indicator of poor diagnosis and level of consciousness at the time of admission is a good criteria for prognosis although it is not accurate and reliable one in cases with cerebrovascular lesion who need special care, treatment and follow up. With respect to the prevalence of hypertension in modern societies, the control of risk factors is the key to the problem. But since incidence of stroke varies from one place to another similar studies in other cities can undoubtedly broadens our understanding in this regard.

Background & Objective: Insulin is the best controlling drug in Type I Diabetes and the self-care related to insulin theraphy is the most important caring action in such patients. There fore this study was aimed to find out the rate of self-care in insulin theraphy among type I diabetic patients.Materials & Methods: This descriptive study was carried out on 139 patients with type I Diabetes. Subjects were selected by the available sampling method. A questionnaire was used for collecting the data about the special features and knowledge level meanwhile an observational checklist and for was applied to record the skill and performance of patients in insulin therapy. To analyze the data descriptive statistics, X2 test and Piersons correlation coefficient (α=5%) were employed. The patient"s knowledge and skill were graded as follows: 0-39 points as poor, 40-65 points as moderate and over 66 points as good.Results: The knowledge of 98.6% of cases about the application of Insulin was at moderate rate. Meanwhile 71.2% and 28.1% had moderate and poor knowledge of insulin side effects. In general 78.8% had moderate knowledge and the rest were poor in the application of insulin and its side effects. 81.3% had good skill in insulin injection, but 18% had moderate performance in this respect. There was significant correlation between this variable and age (r=0.409, P=0.008) as well as the period of having diabetes (r=0.341, P=0.032).Discussion: The findings showed that the knowledge of using insulin and its side effects are in moderate rate, but the skill in insulin injection is good. Young patients with shorter period of having diabetes were more skilled. Insulin therapy is a key to basic treating of type I Diabetes in which self-care can play a major role. It is recommended that researchers put the training of patients as their top priority and promote the patients skill and knowledge about the correct use of insulin and prevention of its side effects.

Background & Objective: Leech biting rarely causes bleeding in Alimentray and Respiratory systems and in genital. Leech saliva contains strong anticoagulant materials. The most important one is Hirudine, which by inhibiting the thrombine causes dysfunction in coagulation. Normally leech is taken by contaminated water and goes inside mouth and nose. The most common places of leech bite are the mucuses of nose and nasopharynx which causes epistraxis and respiratory distress. In rare cases it may stick to profunda muscuses like esophagus and Trachea and causes hematemsis, hemoptysis and respiratory distress. Case report: In Agust 2003 a three and half year old girl from a village in Ilam state was referred with hematsis and due to severe anemia she was transfused packed cell and platelet. The endoscopy showed that leech bite on the esophagus wall was the cause of bleeding. Bleeding stopped when one leech came out through vomiting and another one by froceps.Discussion: In regions where people use natural water, the presence of leech is a possibility. Therefore people should be informed about the dangers of leech and recommended to use filtered and clean water.

Background: Tetralogy of Fallot (TF) is a common congenital disease which to called pantalogy of accompanied with Atrial- Septal Defect (ASD).Case report: A 7-year old girl with TF who underwent a reconstructive operation but soon after arrival at ICU, developed hypertension and synosis. Due to the failure of supportive measures (treatment) the patient was reported with a preoperative diagnosis of intracardiac shunt next day. Intro operative finding was indicative of reopening of ASD due to ruptured sutures. After the repairmen of sutures patients hypotension, hemodynamic disturbances and synosis were subsided and patient was rescued.Discussion: Unresolved intracardiac shunt or its occurrance as a result of ruptured sutures after FT operation may lead to hypotension or synosis. In such cases the patient must undergo both echocardiography and angiography. When diagnosis is made the patient must be repeated urgently.