application of fuzzy multi-attribute group decision making to prioritize the landscapes with high ecological value: Khoshk river in Shiraz

The expansion of major cities regardless of the scientific planning principles has led to the emergence of negative urban development impacts in Iran such as the degradation of natural resources and various forms of pollution. Undoubtedly, urban rivers can enhance the ecological value of the earth to an optimal extent. However, to benefit from these potentials, appropriate planning looks inevitable. Due to the lack of data and information, analyzing the quality of these resources requires the application of new methods which consider the uncertainties and complexities of the issue in the decision making. This research presents an application of fuzzy TOPSIS multi attribute group decision making to identify factors causing land degradation, distinguish the most optimal areas based on their ecological values and provide suggestions on landscape improvement. To this end, the development of Shiraz city along the Khoshk River corridor was investigated using the 1:25000 maps and satellite images [ICONOS]. With respect to the river attributes and adjacent lands, the riverside was divided into four heterogeneous zones. Then, to distinguish the most optimal zone based on the ecological values, the fuzzy decision making method was applied. To this end, the expansion of human activities and biophysical criteria were defined, separately. A number of experts determined the importance of each indicator qualitatively. Finally, using the group decision making theory and fuzzy TOPSIS technique, the researchers identified the most suitable zone based on the [biophysical criteria] and [human activity criteri] separately as well as the whole criteria, and provided suggestions on the landscape improvement

Acute lupus peritonitis associated with massive ascites

Systemic lupus erythematosus [SLE] is an autoimmune disease with multiple organ involvements and abdominal pain as the most common gastrointestinal symptom. Herein, we describe a case of SLE presented with abdominal pain and massive ascites that had a good response to the high dose of prednisolone

effect of Benson relaxation therapy on anxiety level and severity of symptoms in patients with irritable bowel syndrome

Irritable bowel syndrome [IBS] is the most common functional bowel disorder. Stress triggers or aggravates it's symptoms. This investigation is carried out to determine the effect of Benson relaxation therapy on anxiety level and severity of symptoms in patients with irritable bowel syndrome. In this clinical trial 30 patients with irritable bowel syndrom were randomly divided into case and control groups. The control group was treated by only usual medical therapy but the case group was treated by combined medical-relaxational therapy. The two groups continued therapy for three months. Anxiety level and gastrointestinal symptoms of case and control groups were compared at three different times [two weeks before intervention and one week and three months after intervention]. Also, patients were asked to document 6 common gastrointestinal symptoms in their daily symptom diaries, 2 weeks before intervention to 3 months after intervention. At the end of each week, these symptoms were compared in the two groups. Data was analyzed using chi square, Man - Whitney U and Wilcoxon tests. Mean state and trait anxiety of the case and control groups two weeks before and one week after intervention did not show significant difference. But the results after 3 months showed a significant difference [p<0.001].The mean severity of gastrointestinal symptoms, 2 weeks before intervention, was significantly higher in case group, but the comparison of gastrointestinal symptoms severity, 1 week after intervention, did not show any significant difference between the two groups, and 3 months after intervention a significant difference was observed in the two groups [the control group had more severe symptoms than the case group]. The comparison of 6 common gastrointestinal symptoms based on weekly self-report showed that abdominal pain, eructation and distention were significantly lower in case group, but there was no significant difference between diarrhea and constipation. Three months Benson relaxation therapy significantly decreased the state and trait anxiety level and severity of symptoms in patients with irritable bowel syndrome

[Vertical vein banding in treatment of TAPVC]

TAPVc is a rare and known cardiac malformation in which there is no direct connection between any pulmonary vein and the left atrium, rather, all pulmonary veins connect to the right atrium,thus the ASD or PFO is necessary for survival after birth. This anomaly has four types that include: cardiac -supra cardiac-infra cardiac and mixed type. Based on drainage of pulmonary veins, that treatment in all types, soon after diagnosis is made is surgical treatment. The prescribed surgical technique, after median sternotomy and hypothermic circulatory arrest, the first stage is ligation and division of vertical vein [connection between left pulmonary vein and innominat vein] and then total correction based on the anatomy. If total correction was done in neonates and infancy period, operative mortality seems to be low but in old age is high because of pulmonary artery hypertension. The aim of this study is to introduce a two stage repair in patients who dont tolerate one stage repair. The vertical vein is kept intact and snared, If pulmonary hypertension and failure occur, opening and appropriately banding this vein will relieve the pulmonary hypertension and associated failure. Two patients with TAPVC types cardiac and Supra cardiac in GHAEM HOSPITAL had cardiac surgery with CPB as usual manner, we ligated vertical vein but not divided it, and then total correction had been done via right atrium and in final of operation we closed ASD, but weaning from CPB was impossible and pulmonary edema and hypotention occurred. With opening of vertical vein, all symptoms were obscured and weaning from CPB was done very well and patients were transferred to ICU division with hemodynamically stability condition. Because of older age of these patients and occurred pulmonary hypertension [PA-pressure = 50 mmgh] and lower left atrial cavity we had hypertensive pulmonary artey crises,and with opening of vertical vein, all symptoms resolve,therfore, recommended: in older children with TAPVC, first, vertical vein should not be closed and in latest stage of operation if condition of patient is good then closure of it done

Acne fulminans associated with reactive polyarthritis: report of a case and review of the literature

We describe a 16year old boy with acne fulminans associated with axial and peripheral polyarthritis. The patient's clinical course and therapy with isotretinoin, prednisolone and oxytetracycline are described. A possible association between the presence ofHLA-B27 antigen and reactive arthritis with acne fulminans in this case is evaluated. A review of the literature is included

Unilateral upper limb lymphoedema associated with rheumatoid arthritis

Two rheumatoid arthritis [RA] patients with lymphoedema of the hands and forearms are described. Rheumatoid factors [RF] were absent from serum samples of these patients. Radiographs of hands and wrists showed erosive changes in one patient. Treatment consisted of diclofenac sodium, chloroquine phosphate and intramuscular gold therapy in both patients. Gold therapy was changed to methotrexate in one patient because of gold toxicity. Lymphoedema persisted throughout the follow-up in one case for about ten years with incomplete temporary remission during her course of disease after a second delivery. The results indicate that the lymphoedema is resistant to treatment. There was no correlation between lymphoedema and the severity of the disease. Vigorous therapy is not needed and conservative management is suggested for such extra-articular manifestations in rheumatoid arthritis patients

Adverse reactions of gold sodium thiomalate in rheumatoid arthritis patients in southern Iran

To confirm the side-effects of gold sodium thiomalate [GSTM], we carried out a retrospective study examining 102 consecutive patients with rheumatoid arthritis attending the Rheumatology Unit of Hafez Hospital, Shiraz, Iran, in whom GSTM was initiated between 1983-1989. Only patients with classical or definite RA [ARA criteria] were included in this study. Patients were categorized as having developed toxicity to gold if rash, stomatitis, leukopenia [<4000/mm3], thrombocytopenia [<100,000/mm3], anemia [Hb<10gm/dL], microscopic hematuria [more than 5 RBC in each HPF] and proteinuria [1+or more] appeared during chrysotherapy. Sixty-six [64.7%] patients developed adverse reactions. More significant side-effects were pruritus [57.8%], eosinophilia [23.5%], microscopic hematuria [20.5%], and low Hb [20.5%]. Inadequate primary response and relapses on therapy accounted for termination in 15.6% of patients, nephrotic syndrome in 0.9%, hepatitis in 1.9%, colitis in 2.9%, persistent pruritus in 1.9%, extensive lichenoid rash in 3.9%, persistent stomal ulcer in 0.9% and persistent hematuria in 1.9% of patients. Lichenoid rash was more significant and more extensive in our series compared to others

Pyoderma gangrenosum associated with systemic lupus erythematosus: a report of three cases and review of the literature

A variety of systemic diseases may be found in association with pyoderma gangrenosum [PG]. Association of PG with systemic lupus erythematosus [SLE] is rare. To our knowledge, only four cases have been reported. In this study three more patients with SLE who have developed PG are presented. The association of pyoderma gangrenosum with SLE is reviewed and some aspects of clinical and histological findings in SLE and non SLE-associated PG are discussed

Tuberculous arthritis of the knee; a study of ten patients

Clinical presentation, laboratory and radiological findings, synovial fluid and tissue examination,and the outcome of therapy were analyzed in ten patients with tuberculous arthritis of the knee. None of the patients had active pulmonary tuberculosis, and only one had extrapulmonary tuberculous disease. History of joint trauma was present in two cases. The synovial fluid was inflammatory in type, contained microscopic amounts of RBC, and had high protein and low glucose concentrations. Radiological examination showed varying degrees of subarticular cystic changes and bone erosion in seven of ten cases. Closed synovial needle biopsy was diagnostic in nine of the ten patients. The procedure was safe and there were no complications. There was good overall response to antituberculosis therapy with complete to near complete remission in most patients. Tuberculous arthritis should be suspected in patients with mono-articular arthritis of a chronic nature [months to years] not responsive to anti-inflammatory agents. Early diagnosis is of extreme importance since good recovery can be gained if the damage is not extensive

Efficacy of closed synovial needle biopsy in tuberculous arthritis of the knee

Closed synovial needle biopsy was performed in ten patients with tuberculous arthritis of the knee. With one attempt at closed synovial needle biopsy, the diagnosis was made in nine out of ten cases on the basis of granulomata with typical giant cells and/or positive acid-fast staining of the tissue. This method could be of value in places where no facilities are available for the culture of T.B. organism. With a second attempt of closed needle biopsy the positivity, using the same criteria, increased to ten out of ten. It is suggested that closed synovial needle biopsy in patients suspected of having tuberculous arthritis is preferable to open surgical methods both in its safety and diagnostic accuracy, specially where hospital facilities are not available