Journal of Kermanshah University of Medical Sciences
Year:2005 | Volume:9 | Issue:3|Papers Count:9

Introduction: Fat embolism is a rare but serious consequence of fracture which is also potentially fatal.  It is caused by the occlusion of blood vessels by fat globules in the brain and lungs, causing bleeding into the alveoli and the disruption of oxygen transfer. Clinical manifestations are: respiratory failure, loss of consciousness, fever, tachycardia and petchiae, all following the fracture of a lower organ. Appropriate care can reduce its incidence through fixing of the organ and the administration of oxygen, electrolytes, rehydration and suitable analgesics. The objective of this research was to study the lower organ fractured patients (LOFPs) referred to the Talaghani Hospital of Kermanshah during 2003-4. Materials and methods:This descriptive study examined 627 LOFPs injured during the mentioned period. 13 of these patients also suffered from fat embolism and were thus selected and studied with respect to the location of the fracture and clinical symptoms. Descriptive statistics were used to analyze the data, separating out thigh and foreleg fractures. Results:Out of 13 subjects, 46% suffered from thigh fractures, 30.7% from foreleg fractures and 13.3% suffered from fractures in both locations. Respiratory failure, loss of consciousness, fever and disorders of blood artery gases were reported in 84.6%, 53.8%, and 22.3% respectively. 62.2% of fractures leading to embolism were caused by car accidents. Conclusion:The incidence of fat embolisms was higher in LOFPs referred to the Taleghani Hospital of Kermanshah than in other places. The conspicuous clinical symptoms observed in this study were the same as those cited in the previous studies and thus comparable.  It is recommended that care providers take great care to prevent fat embolisms following the fractures of lower organs.

Introduction: Oxalate oxidase (EC.1, 2, 3, 4), an acute phase protein of plants, is used widely in agriculture, food industries, medical diagnosis of kidney stones and oxaluria. In this study oxalate oxidase from barley was purified and partially characterized. Materials & Methods: Roots and sprouts of barley cultured in hydroponic states were separated and extracted. Ion exchange resins of the enzyme were done through heat treatment (80°C, 3min), ammonium sulphate fractionation and two-step chromatography. Purification and weight-determining of the enzyme were done by DEAE-Cellulose and DEAE-Sepharose fast flow, respectively. The enzyme activity was measured by spectrophotometric and specific gel staining methods. Purity and molecular mass of the product was estimated using SDS-PAGE. Isoelectric points (pIs) of the separated enzymes were estimated using chromatofocusing and isoelectric focusing. In addition, the effect of different concentrations of urea and denaturing agents were tested on the enzyme activity.  Results: Oxalate oxidase was purified at least 688-fold with purity of more than 90 percent. The molecular mass of the enzyme was estimated to be 25-26 and 115-120 KDa, respectively in reducing and non-reducing SDS-PAGE. The enzyme sub-units showed no activity in the specific gel staining method. At least two isoenzymes with pIs of 6.8 and 6-6.2 were identified. The purified enzyme was resistant to many denaturing agents such as heat, urea and detergents. These characteristics make oxalate oxidase a suitable enzyme for oxalate assays. Conclusion: So in accordance with the obtaind data from this study, it can be concluded that we can utilize the purification method of this enzyme for measuring oxalate.

Introduction: Medical professionals are often under the influence of stress due to the responsibility of providing patients with comfort and care.  Working conditions in hospitals create much stress and anxiety and can affect the health of staff, especially the nurses.  This study was designed to investigate the job stressors of nursing personnel in the emergency wards of Zahedans’ hospitals during 2004. Materials & Methods: This descriptive study investigated the levels of occupational stress and general health in 63 nurses working in the emergency wards of hospitals in the city of Zahedan.  It was conducted using the Goldberg Standard General Health Questionnaire-28 as well as a questionnaire indicating managerial, interpersonal, physical and personal stresses. Results: The results showed that tension-creating factors in the studied individuals were mostly care-related stressors (2/54) and managerial stressors (2/28) respectively. The levels of stress were higher in nurses than in nurse hands (Behyars). Statistical analysis (T-test) showed a significant difference between nurses & nurse hands regarding managerial (p=0/02) and personal factors (p=0/03). There was also a significantly negative correlation between general level of health amongst staffs and job-related stress (r=-0.3).Conclusion: The prevalence of stress in the personnel of the emergency wards of this study necessitates the modification of management structures, as well as the reduction of  care-related and personal stress.  Such improvements might reduce the degree of psychological pressure and occupational burnout and help improve the mental health of nurses.

Introduction: Angiogenesis play an important role in many physiological processes (embryonic growth, tissue repair, etc) and also in pathological ones (diabetes, retinopathy, arthritis, tumor growth, etc). Evaluation of endothelial cell growth and finally new vessel development in vivo is a complex and often difficult task. Materials & Methods:To address this issue an in vitro experimental angiogenesis model was designed. This model is controllable, has a high reproducibility rate and at the same time enables the user to study various parameters involved in angiogenesis.This model used beads covered with endothelial cells of bone marrow capillaries as source of endothelial cells and therefore the three-dimensional structure required for endothelial cell growth by fibrin gel was created. Results: Growth migration of endothelial cells is provided through fibrin gel.  In this model 5-7 days after culturing endothelial cells, the growth and migration of cells (and therefore formation of capillaries) were observed branching out from the source endothelial cells. Conclusion: Using this model, angiogenic and anti-angiogenic agents can be studied and screened.  

Introduction: Contrary to medical advice, some Muslim pregnant women fast during Ramadan.  The aim of this study is to determine the effect of fasting on the ponderal index of their neonates. Materials and Methods: This retrospective study looked at a cohort of 179 neonates of pregnant women whose Ramadan month fell in the third trimester at Besat Hospital of Sanandaj. 62 of these women had fasted during Ramadan compared to 100 who had not, and thus the latter acted as a control group.  The 17 mothers who had fasted were excluded from the study.The data were collected through interviews with the mothers and examination of hospital documents and were analyzed by independent T-test, Kruskal-Wallis and ANOVA . Results: In this study the difference between mean birthweight of the both groups was not statistically significant (3,313.0g ± 533 and 3,346.5g ± 377 respectively).  There were no statistically-significant differences between mean supine length (49.74cm ±1.84 and 49.9cm ± 1.89) and head circumference (39.65cm ±1.57 and 34.57cm ±1.37) too. Conclusion: Fasting during the third trimester of pregnancy has no effect on the anthropometric indexes of neonates.

Introduction:Compared to other developed countries, the maternal mortality rate is much higher in Iran.  Bleeding, infection and gestational hypertension are the main causes of maternal mortality and abortion is a major cause of bleeding and infection.The objective of this study was to determine the incidence of abortion and its effect on maternal mortality. Materials and methods: This descriptive study examined all records of pregnancies and abortions during 1992-2002 in Mo’tazedi Hospital of Kermanshah.The maternal mortality rate was determined per 100,000 births and the abortion rate determined per 1,000 live births. Results: During this decade 115,647 births were reported.The incidence of abortion was 115.3 per 1,000 live births. Complications associated with induced abortions were the cause of 9% of all maternal mortality.The annual trend of the maternal mortality rate and the incidence of abortion decreased in the second half of this decade. Conclusion: In this decade, abortion was the cause of 9% of all maternal mortality. The decreasing incidence of abortion in the second half of the decade may be due to either the application of total legation or the lack of referrals to the hospital. Determination of the underlying causes of the observed changes needs further researches in the Province of Kermanshah.

Introduction: Iranian universities of medical sciences are ranking by the results of biannual Pre- Internship and Basic Sciences Comprehensive Exams (PICE and BSCE). The present study was conducted to determine the agreement rate of these two exams as an index for ranking Kermanshah University of Medical Sciences (KUMS) amongst other universities. Materials and Methods: In this descriptive-analytical study, KUMS ranking results were surveyed in 20 PICE and 25 BSCE periods during 1990–2002 by determining percentage ranking and median grade as a cut-off point.  Kappa Agreement Coefficients (KAC) in two cases (contemporaneous and 3-year intervals) was calculated.  This coefficient was separately calculated for "exam month performance" (September and February) and "number of participants" (<50 and ≥50). Results: Kappa agreement coefficient for two exams in all periods for the first case (contemporaneous) was 0.20, compared to 0.05 for the second case (3-year intervals between two exams). KAC in each of the cases was calculated for four sub-groups (September, February, <50 and ≥50 students). Only in the first case (<50 students sub-group) it was statistically significant (p=0.004). Conclusion: In this study the agreement rate between PICE and BSCE for two different cases was calculated. In both cases KAC was very low, showing no valuable agreement between the two mentioned exams in their assessment of KUMS ranking amongst other universities. This means that each exam evaluates two different aspects of university ranking. Regarding the high KAC in two exams in the "<50 students" sub-group it seems that the special characteristics of students who could not pass their courses on time and thus could not participate in routine comprehensive exams led to this result.

Introduction: Mycobacterial tuberculosis (TB) infection is a serious opportunistic infection in renal transplant patients. Although TB is normally considered as an opportunistic infection of the early period, it can be diagnosed at any time. In this study four patients who suffered from TB were examined. Cases Report: Among 200 patients who were monthly examined in Sina Hospital of Tehran, TB was found in four patients, with two presenting <1 year after surgery and others after 5 years.TB was diagnosed by smear, culture, pathology and chest radiography. Three cases presented with pulmonary TB and another with PIE. Three of them had negative PPD test before transplantation. Cyclosporine serum levels were monitored in all cases and in two cases dosage was increased. Hepatotoxicity occurred in one case and all of the cases had functioning grafts.Conclusion: As TB is an endemic disease in Iran; we should consider it in every kidney transplant patient with lung problems.