Journal of Kermanshah University of Medical Sciences
Year:2000 | Volume:4 | Issue:1|Papers Count:12

The Intra Aortic Balloon Pump (IABP) by after load reduction, improvement in coronary perfusion, decrease in end diastolic pressure and volume and influence on myocardial oxygen supply demand, can have vital effect on low cardiac output patients after open heart surgery. To study these effects, a perspective study was carried out on low cardiac output patients which have not responded to maximum medical treatments.The number of patients was 21. Their homodynamic status was compared before and after insertion of IABP. 15 cases were men and 6 were women. The mean age of cases was 54.8 year (28-68). In 19 cases CABG was performed. In one case the operation was 2-valve replacement and in another one was valvular malfunction. Most of patients have suffered from hypertension (71%), left ventricular dysfunction (71%) and diabetes mellitus (57%). The mean cardiopulmonary bypass time was 161 minutes and aortic cross clamp duration was 85 minutes. The mean duration of IABP support was 53 hours (7-295hrs). 18 patients were separated from the IABP successfully and discharged from the hospital. There were 3 cases of mortality: one of them died on the 15th postoperative day as a result of respiratory failure. The other did not respond to ventricular assist device. And the third one died as a result of severs heart failure. The only complication of IABP was large hematoma of the groin in one case.This study showed that the early insertion of IABP and late separation were important factors in increasing the success: it was also made clear that CABG patients, which do not respond to enough doses of dopamine and doputamin and require adrenaline, can be treated with IABP instead, because the requirement of adrenaline in fact is an indicative of sever dysfunction of myocardium. The final result is that the use of IABP with 1-2 .mode is preferred to 1-1 mode, especially in heart rates more than 100 bpm and the management of IABP by expert personnel is of high importance to guarantee the better success.

Peroxidase ((PRO) (EC.1.11.1.7)) has applications in many diagnostic procedures such as ELISA and immunoperoxidase. Concerning HRP related products; we are dependent to other countries. Therefore the purification of PRO can be an economically important object. Raphanus sativus Var Niggera was tested to be a suitable source for PRO purification. The steps of purification were included: extraction by phosphate buffer (0.05 M, pH 7), ethanol and ammonium sulfate precipitation and ion-exchange chromatography on DEAE-Cellulose. Based on the affinity to DEAE-Cellulose column a major alkalin form and one minor acidic form of PRO were detected. The fold of purification was 102 and the recovery was 67%. The molecular weight and Rz for the alkalin isoenzyme were calculated to be 40000 daltons and 1.95, respectively. The extent of enzyme purity was verified by SDS-PAGE. Regarding the economical point of view, mass production of this enzyme as internal product is suggested.

This research has been carried out to study the subjective symptoms related to toluene and xylene exposures in a paint manufacturing in Tehran and their relationships with the workers exposures to these solvents.This is a case-control study. Some 42 workers were selected from production sectors as case group and 43 individuals were chosen from administrative sector as the control group. Regarding work situation and the amount of pollutants exposure, the case group was divided into occupational subgroups. Totally some 175 samples were collected from individuals breathing zones by activated charcoal tubes as short and long term samples based on the standard method recommended by ASTM and NIOSH, and quantitatively determined by a gas chromatograph device. To study the subjective symptoms a reliable and valid questionnaire was used which had two parts: one was related to individual’s symptoms during the work performance and the other was concerned to the symptoms appeared outside the workplace during the previous year.The obtained results from breathing zone sampling suggested that the maximum amount of the solvents time weighted average (TWA) in the respiratory air of occupational groups in case group was equal to 76±39.9 percent of mixed threshold limit value that had no statistical significant difference with the workers exposure limit, but in other case subgroups were significantly lower than the threshold limit value (P<0.001). However in short term samples in some groups the exposure amounts were even 5 times of the mixed threshold limit vabes.The research findings revealed that during work performance there were significant relationships amongst workers exposure  to toluene and xylene and the incidence of following symptoms : nasal and eye irritation, unusual odour sensation, face flashing, unusual taste (P<0.05), heavy feeling in head (P<0.005), and floating sensation(P<0.05).There were also significant relationships amongst the incidence or the following symptoms and workers exposure to toluene and xylene outside the workplace: hand skin sensitiveness (P<0.005), dyspenia, low appetite, tinnitus, feet skin sensitiveness, successive coughing (P<0.01), nightmare, anxiety, tachypenia, whole body numbness, xerostomia, skin roughness, and throat itching sensation (P<0.05).Considering the observed relationships among the symptoms and the workers exposure to the solvents, it can be concluded that the exposure limit or exposure to less than the threshold value does not guarantee safety and required measures should be done to eliminate the pollutants from workplace air. It is proposed to separate the high polluted sectors of the firm from other parts to prevent the incidence of symptoms and disorders.

Today one of the most common causes of mortality in the world is cardiac ischemic diseases. Regarding the oxygen demand increase in the hypertrophy heart, its vulnerability to ischemia raises and this research was aimed to find the answer to the question whether it is possible to reduce the vulnerability by an intervention in the process of cardiac hypertrophia. The present study was carried out on three groups of rats (n=37) selected randomly: The first group received 0.4 mg/kg/day Isoproterenol (ISO) for seven successive days. Similarly, the second group received 0.12 mg/kg/day ISO with cyanide and the last group, as a control group, was prescribed with the same volume of normal saline. Then the rat hearts were isolated and perfused in normal periods (20 min), ischemic periods (by perfusion reduction to the initial state for 30 min) and turn to normal state (30 min). The results indicated that LVP and dp/dt in the first group (95.73±11.44 mmHg, 3575± 5.9mmHg/sec.) and the second one (89.9±11.04mmHg, 2102± 22mmHg/sec.) were more of the control group (58.06± 7.16mmHg, 1500±222mmHg/sec.) and the differences among experimental groups and control group were statistically significant (P<0.005, P<0.025). Meanwhile the percent rates of alterations of LVP and dp/dt after the ischemic period in the first group (-21.64± 6.94, -42.03 ± 6) were significantly decreased in comparison to control group (26.83 ±14.42, 22.23 ± 17.47), while these alterations were not seen in the second group (0.137 ±15.08, 12.85 ±21.91).These results, on the one hand, suggested the incidence of hypertrophy in both experimental groups relative to control group. On the other hand, the heart received ISO with cyanide were less vulnerable to ischemia than those received merely ISO. This probably is due to the effect of cyanide on cytochrome oxidase and the activation of the aforementioned protective mechanism which needs more complementary studies to clear up its mechanisms.

Most often, the fatal disease of rhinocerebral mucormycosis was reported in diabetic patients, while candida albicans yeast does not cause such a killing disease, therefore in this descriptive-analytical study serous responses of 100 diabetic patients and 100 healthy (non-diabetic) individuals were evaluated against rhizopus oryzae (the most common cause of mucormycosis) and candida albicans (body saprophyte yeast which cannot cause rhinocerebral from in diabetic patients) by CIE (contra immuno electrophoresis) technique.The obtained results revealed that the diabetic patients had more positive responses against the aforementioned antigens than the healthy individuals (p<0.001). There were also more positive responses to candida albicans than to rhizopus oruzae among the diabetic patients (P<0.001). It seems that this is due to the frequency or candida mucous infections and high colonization of candida yeast relative to rhizopus in diabetic patients.

Regarding the increasing development of Salmonella typhi resistance to antibiotics and the importance of recognition of its factor, this research was carried out on the patients suffering from typhoid fever to determine the characteristics of the factor in Tehran Taleghani hospital in 1996. To grasp this goal, some 44 stains of Salmonella typhi were isolated from blood of patients with typhoid fever. The study was carried out to estimate the degree of Salmonella typhi resistance to some antibiotics by Disk diffusion. After the verification of the resistant plasmid by conjugation, its molecular weight was determined by electrophoresis. By the use of plasmid purification kit, plasmid DNA of resistant Salmonella typhi stains (as donors) and the transconjugants obtained through conjugation of resistant stains of Salmonella typhi and Escherichia Coli resistant to sodium azid (as recipients) were extracted. The purified extract was electrophoresed on agar gel. The results indicated that 29.5% of isolated stains were resistant to CB, TE, SXT, AM and C. All stains were found to be susceptible to CP, CFX, CT, CF, K and GM. Finally, a R-Factor with the molecular weight of 60-65 MD (90-100 Kb) was isolated which was the resistance transfer factor to several antibiotics such as C, SXT, TE and AM. These are the most common antibiotics used in the treatment of typhoid fever. Similar studies on the genetic patterns of microbial resistance ought to be carried out at many time intervals in order to see the changing patterns of Salmonella resistance in Iran.

Due to increase of delivery with episiotomy and different view about the kind of catgut for repair of episiotomy, this research was aimed to compare the incidence of infection and the amount of pain when using chromic or plain catgut. This clinical trial was carried on 180 primi gravid mothers randomly selected from Imam Khomeyni hospital of Tehran in 1998. Mothers were randomly divided into two ninety groups. They were matched in terms of age, percentage of weight/height, race, socio- economic and hygienic status, length of incision and duration of repair. Mediolateral episiotomy was repaired by two zero chromic and plain catgut (both from supa institution brand). The same technique was used for the repair of all the layers of episiotomy except the skin for both groups. The skin was repaired with plain catgut in one group and with chromic one in another group. Scaled ruler was used to measure pain. In the chromic group %48.8 of the mothers were experienced severe and moderate pain in the second day and %37.7 in the 7th and %15.5 in the 15th day. In the plain group those experienced the pain were %36.5, %27.8 and %10 in the 2nd, 7th and 15th day, respectively. There was no significant difference between two groups in the 2nd day by using X2 and t tests (P<0.24). There was statistically significant difference in experiencing pain in 7th day (P<0.0004) and 15th day (P<0.0002).Chromic group was experienced more severe pain than the other group. Infection of wound was not seen in two groups. Thus we concluded that plain catgut is the better choice for the repair of skin in episiotomy

The recognition of postural anomalies in heavy tasks such as MMH (manual material handling) plays an important role in prevention and reduction of treatment costs. This study was carried out to determine the prevalence of postural anomalies in lifting load workers of Behshahr industrial factory in 1995.This descriptive study was achieved on all 37 lifting load workers in the factory. To study the postural anomalies, the workers were requested to stand behind the posture screen. Then their body postures were evaluated by the use of New York test/posture score sheet and photographs from back and latheral view in 3 levels of good, fair and poor. In the back view, head, shoulders, spinal column and pelvic positions were studied and in latheral view, Neck, back, lumbar and abdomen were examined. The obtained data were presented by employing descriptive statistics. The mean ± SD age of workers was 27.7±4.2 and its range was 20-30 years. The results from the back view indicated that the outbreak rates of affected workers from poor shoulders tilt, pelvic tilt, head latheral tilt and scoliosis were 27%, 32.4%, 18.9% and 24.3%, respectively. The prevalence rates of workers with normal postures relating to head, shoulders, vertebral column and buttock were 21.7%. 8.2%. 35.2% and 24.4%, respectively. Meanwhile, in the latheral view in poor level, 83.7% of workers affected from lordosis, 45.9% from kyphosis, 40.5% from abdomen fall and 35.1% from forward head.Regarding the high prevalence's of these disorders, it is proposed further researches to be conducted to study the causes and the ways of preventing them.

With regard to the prevalence of trauma, its known complications, the existing contradictions about trauma causes and the lack of information about its status in the region, this research was conducted to determine the trauma causes of bed-ridden patients in surgical sector of Taleghani curative-educational centre in 1995. The type of study was the use of available data. Those files possessing necessary information about the trauma causes in patients confined to bed were studied. Some characteristics such as age, sex, trauma cause and its type were extracted from the files and presented by descriptive statistics.The youth were more exposed to trauma by knife and their relative risk was five times of those aged more than 40 and less than 15 years. The mean age of males and females were 27.3±14.2 and 33±18.8years, respectively. The trauma agents were as following: knife stroke (66.7%), accidents (17.5%), gun bullet (7.1%), falling (4.0%) and others (4.7%). The most prevalent injured area was thorax (56.3%). The types of trauma were 78% sharp and 22% blunt.With regard to the trauma prevalent causes and its related consequences and their differences to other reports in this respect, it seems that these events are related to sodo-economic and cultural factors and should be improved by identifying the effective factors and trying to control them.

In recent years, COME is being tested in Iran to create a new field of medical education along with the world health policies. Studying the knowledge and attitude of students experienced this experimental field practically and their suggestions can be useful in modifying executive methods and implementing community oriented medical education system.For this purpose, almost all medical students of kermanshah university of medical sciences who were near the end of their education in 1997 and had passed the COME course in maskan field were studied and the questionnaires(include 11 closed-ended questions about the students knowledge and 3 open-ended questions about advantages and disadvantages of COME) completed for them.The obtained results revealed that the student's knowledge of COME and its objective had been very low (the average score equaled 30.4 from 100). 35% of students evaluated their attitudes about COME as good. 49% of them evaluated the professors’ knowledge of COME as fair and so did 39% of them about professors’ cooperation in executing the plan. Even though almost all the students had accepted the objectives or this educational discipline theoretically, they mostly opposed (73.7%) the method of its practical implementation in kermanshah. Firstly, misjustification and lack of motivation in professors, students and employees were considered as the main problems in implementing this method. Then, field inappropriate location, poor management and incorrect planning were state as other problems. The most important students recommendation was to make professors and students involved in these fields acquainted with the COME course and they themselves accept it so that they can be an appropriate practical model for the students. It seems that with the correct planning, determining the individual responsibilities and scope or duties (for professors, managers and employees), its correct way of implementation will be smooth.

With due attention to the prominence of human productivity in production level increase and quality promotion and confirmation or rejection of some reports suggesting the influence of heat and noise on productivity, the present study was aimed to study the effect of noise and heat on productivity.This experimental research was carried out on 42 healthy workers (from the cardiorespiratory system point of view) having nearly 30 years and worked in hot sectors of a leather and shoe industry. The workers were exposed to temperatures 20-25, 25-30 and more than 30°c of CET index and also to noise intensities of 75 and 93dB. Simultaneously, their human productivity were assessed by computing the number of errors related to product quality during 100 work days and by measuring the consumed energy during cycling on an ergometer with 100 walts workload. The obtained data were evaluated by T-test.The mean ± SD age of workers was 33.7±0.8 years. By changing the temperature from 23.5°c to 27.5°c CET, the errors changed from 25±3.3 to 33±2.5 and by altering it from 23.5°c to more than 30°c CET, the errors altered from 25±3.3 to 56±2.1 (p<0.005). Meanwhile the consumed energy was increased 22.2% and 40.7% by modifying  temperature from 23.5°c to 25.5°c CET and from 27.5°c to more than 30°c CET, respectively (p<0.005). The results indicated that by turning the noise intensity from 75 dB to 93dB with 25°c CET, the work errors were increased  to 48% (p<0.005). This rate was raised to nearly 20% in temperature more than 25°c CET (p<0.005). It is concluded that heat and noise can increase human errors and decrease human efficiency. In investigating the synchronous effects of heat and noise on human errors, it is also noticed that these two factors have increasing impact upon each other and augment the individual errors. In other words the increase in noise and heat can decrease human efficiency. Finally, it is recommended to study the impact of different types of sound upon human productivity.