Complication rates in managing hepatic trauma: a cross-sectional study stratifying their outcomes

Background: Liver trauma is the most commonly observed injured organ in abdominal trauma. The objectives of this study was to determine and evaluate the rates of complication in the management of liver traumaMethods: This cross-sectional observational study using non-probability convenient sampling technique was done at surgical unit of Liaquat University of Medical and Health Sciences, Jamshoro, for 06 months. After ethical approval from Institute’s Institutional Review Board (IRB), patients presenting to surgical emergency of the hospital between ages 16 to 60 years having blunt or penetrating liver trauma within 04 hours of incident, either road traffic accident, sustaining a fall, sporting injury, knife or stab wound were include while patients of liver trauma conservatively managed or had severe co-morbid, not fit for anesthesia, with multiple organs lesions (polytrauma) and all hepatic injury patients that were hemo-dynamically stable were excluded. SPSS version 23 was used for data analysis keeping p-value <0.05 as significant.Results: Among 136 patients with mean age 32.33±11.23 years, 120(88.2%) were males. 122(89.7%) of the patients were admitted due to liver trauma of blunt variety while 14(10%) with penetrating liver injury. Overall mean duration of hospital stay was 13.1±4.58 days. 41(30%) patients reported intra-abdominal sepsis, followed by recurrent hemorrhage in 33(24%) of patients while in 22(16%) of patients, biliary leakage was observed. An insignificant difference persisted in either surgical intervention in terms of the complication rates.Conclusions: Higher complication rates were observed in patients with peri-hepatic packing, however outcome of both surgical techniques in terms of complication rates were found to be insignificant. Further studies are needed to shed light upon the findings or this study.

Outcomes of surgical management of liver trauma at LUMHS Jamshoro

Background: Mortality from liver trauma remains high despite surgical advancements. The objective of this study was to determine the outcomes of surgical management of liver trauma at LUMHS Jamshoro.Methods: A cross-sectional observational study using non-probability convenient sampling technique was done at department of surgery LUMHS Jamshoro for 18 months. Patients between 14 to 50 years with blunt hepatic trauma presenting to the E.R. within 04 hours of incident were included and hepatic trauma patients managed conservatively, having multiple trauma and hemo-dynamically stable were excluded. SPSS version 20 was used for data analysis with mean and SD reported for qualitative and frequency and percentages for quantitative variables. Chi-square test was applied keeping p-value of < 0.05 as statistically significant.Results: From 136 patients with mean age of 32.33±1.23 years, 120 (88%) were male. 122 (89.7%) were admitted due to blunt trauma and 14 (10.3%) due to penetrating trauma. Peri-hepatic packing was performed in 116 (85.2%) and suture hepatorrhaphy in 20 (14.8%). Intra-abdominal sepsis was seen in 41 (30%) of patients followed by recurrent hemorrhage in 33 (24%) while 30 (22%) of patients died. Substantial differences (p < 0.001) were observed in terms of surgical technique and each of the complication i.e. sepsis, bile leak and recurrent hemorrhage among alive patientsConclusions: The most common post-operative complication was intra-abdominal sepsis followed by recurrent haemorrhage and bile leak. Significant mortality was observed in between type of complication as well as surgical technique.

A Case Study of the Effects of Posttraumatic Stress Disorder on Operational Fire Service Personnel Within the Lancashire Fire and Rescue Service

BACKGROUND: Lancashire Fire and Rescue Service (LFRS), the subject of this evaluative research document employs 1400 people. 80% of employees are operational firefighters and officers whom operate across a range of duty systems and support functions, providing prevention, protection and emergency response to the communities of Lancashire. METHODS: The overarching purpose of this epidemiological study is to assess the prevalence of post-traumatic stress disorder (PTSD) amongst operational LFRS personnel and to analyse the effects upon those who may be suffering from it, whether brought about by a single traumatic event or by repeated exposure to traumatic occurrences over a period of time. A combination of primary and secondary research was carried out. Primary data was collated using two recognised clinical questionnaires and statistical analysis was conducted with the aid of the software package SPSS. RESULTS: The findings and statistical analysis showed that out of the 100 people surveyed, 30% of respondents had signs of probable distress. Of this quota, 4% showed symptoms of PTSD. The study considers how an organisation can recognise and manage PTSD and provides recommendations to assist in better recognising and managing the associated risks. CONCLUSION: Based upon the findings, the authors conclude that the level of PTSD within LFRS is slightly lower than those found in other studies undertaken within the Fire and Rescue Service sector. The paper provides recommendations for future studies and a series of actions for consideration by LFRS senior management to improve PTSD support services for employees.

Distribution and ecological aspects of sand flies (Diptera: Psychodidae) species in Northeastern Iran

Objective:To determine both the distribution and the ecological characteristics of sand flies in Golestan Province, northeast of Iran in 2016.Methods:In this study, 34 villages were selected based on their geographical conditions. Sticky paper traps were used for collecting the sand flies. Sampling was carried out in each of villages from May to November. In each village, 60 traps for indoors and 60 for outdoors were monthly installed. The species of all collected sand flies were determined using approved morphological keys. Pearson coefficient correlation was used to find the relationship between the number of collected Phlebotomus papatasi from different villages and incidence rate of zoonotic cutaneous leishmaniasis as well as the number of positive cases of the disease. The altitude of the studied villages was extracted from digital elevation model of the area using GIS and vegetation cover density index of the province was extracted from Modis satellite imagery and distribution map of sand flies drown up.Results:Overall, 5 428 sand flies were collected and identified, belonging to 18 species. Phlebotomus wenyoni was reported for the first time from the area in this study. The frequency of sand flies in the villages located in northeast of the Golestan province (the plateau area, lower altitude, arid and semi-arid climates, and lower vegetation cover density), were more than other villages in this province. There was a significant correlation between the number of collected Phlebotomus papatasi and incidence rate of the zoonotic cutaneous leishmaniasis cases in different villages (r=0.837, P=0.019) as well as the number of positive cases of the disease (r=0.688, P<0.001).Conclusions:In the northeaster areas of Golestan Province which is known as the endemic foci of zoonotic cutaneous leishmaniasis, the abundance of sand flies were more and the conditions for their growth and development were more appropriate.

Antioxidant capacity of several Iranian, wild and cultivated strains of the button mushroom

The white button mushroom, Agaricus bisporus, is the most commonly grown mushroom in Iran; however, there is a significant shortage of research on its antioxidant activity and other medicinal properties. The aim of this study was to evaluate antioxidant capacity of the methanolic extracts from four cultivated strains and four Internal Transcribed Spacer (ITS)-identified, Iranian wild isolates of A. bisporus. Evaluations were made for total phenols, flavonoids and anthocyanins, and 2, 2-diphenyl-1-picrylhydrazyl (DPPH) scavenging activity. Overall, results showed that all the wild isolates exhibited significantly lower DPPH-derived EC₅₀, compared to the cultivated strains (p < 0.05). A relatively high relationship was observed between total phenols and flavonoids or anthocyanins (r² > 0.60). However, these constituents could not statistically differentiate the group of wild samples from the cultivated ones, and there was low correlation with the DPPH-derived EC₅₀s (r² < 0.40). In conclusion, comparisons showed that wild isolate 4 and cultivated strains A15 and H1 had higher antioxidant capacity than the others (p < 0.05). This result identifies these mushrooms as good candidates for further investigation.

Development and Validation of a Safety Climate Scale for Manufacturing Industry

BACKGROUND: This paper describes the development of a scale for measuring safety climate. METHODS: This study was conducted in six manufacturing companies in Iran. The scale developed through conducting a literature review about the safety climate and constructing a question pool. The number of items was reduced to 71 after performing a screening process. RESULTS: The result of content validity analysis showed that 59 items had excellent item content validity index (> or = 0.78) and content validity ratio (> 0.38). The exploratory factor analysis resulted in eight safety climate dimensions. The reliability value for the final 45-item scale was 0.96. The result of confirmatory factor analysis showed that the safety climate model is satisfactory. CONCLUSION: This study produced a valid and reliable scale for measuring safety climate in manufacturing companies.

Role of apoptosis-inducing factor (Aif) in the T cell lineage.

Multiple checkpoints regulating finely balanced death-versus-survival decisions characterize both thymic development and peripheral homeostasis of T lymphocytes. While exploring the mechanisms of T cell death involved at various stages during the life of a T cell, we have observed and reported a variety of non-redundant roles for apoptosis inducing factor (Aif), a mitochondrial flavoprotein. Aif is ubiquitously expressed in all cell lineages and functions as an NADH oxidase in its mitochondrial location. It is released following the mitochondrial death signals, whereupon it translocates to the nucleus, binds to DNA and causes large-scale DNA fragmentation. During T cell development, Aif is important for developing thymocytes to navigate the double negative (DN)3 to DN4 transition (beta-selection), via its oxidoreductase property which protects the rapidly proliferating cells from death due to reactive oxygen species (ROS). In peripheral mature T cells, Aif deficiency leads to an increased susceptibility of T cell blasts to activation induced cell death (AICD), possibly mediated by its antioxidant function, and decreased sensitivity to neglect-induced death (NID). Thus, Aif seems to have pro-apoptotic and anti-apoptotic roles in the same lineage in different contexts and at different stages. Surprisingly, in the closely related B lymphocyte lineage, Aif deficiency does not result in any abnormality. These findings generate the possibility of specific T cell dysfunction in human disease caused by Aif deficiency, as well as in mitochondriopathies due to other causes. Also, these data raise questions regarding the basis of lineage-specific consequences of the dysfunction/deficiency of apparently ubiquitous molecules.

Consideration of Climate Conditions in Reservoir Operation Using Fuzzy Inference System (FIS).

In this paper, the Fuzzy Inference System is used for developing an operation model for the Zayandeh-Rud Dam and for planning downstream agricultural crop farms under different climatic conditions. The model consists of three stages: in the first, the storage volume of the reservoir in March is predicted based on both the inflow into the reservoir during the last three months and the Southern Oscillation Index (SOI) using the Adaptive Network-based Fuzzy Inference System (ANFIS). The second stage involves forecasting the annual release in the following year as the model output using both the reservoir storage in the last month of the previous year and the amount of Snow Water Equivalent (SWE) as FIS inputs. As the annual release from the reservoir has definitive effects on the cropping schedule, it may be regarded as a defining factor for climate conditions. The optimized planning of crops for the following year is developed based on the annual release from the dam as forecasted by the fuzzy rules in the third stage of the model. Comparison of observed data and FIS estimations shows that the method developed here is capable of making reasonable decisions about land use and improved crop patterns based on climate conditions. The results also show that the Mean Average Error (MAE) for calculating the water demand is lower than 4.0 percent and, further, that in the case of predicting the cropping area, this error is lower than 2.0 percent.

Diabetes distress and its association with depression in patients with type 2 diabetes in Iran

Patients with diabetes experience some level of emotional distress varying from disease-specific distress to general symptoms of anxiety and depression. Since empirical data about symptom distress in relation to diabetes are sparse in Iran, this study was designed to assess the diabetes-specific distress in Iranian population. Persian version of Diabetes Distress Scale [DDS] questionnaire was completed by volunteer outpatients on a consecutive basis between February 2009 and July 2010, in Endocrine Research Center [Firouzgar Hospital]. Then, scheduled appointments were made with a psychiatrist in the same week following completion of the questionnaire. The psychiatrist was not aware about the results of this questionnaire and patients were interviewed based on DSM-IV criteria. One hundred and eighty-five patients completed the questionnaire and were interviewed by a psychiatrist. Fifty-two percent of the patients were females. The mean age was 56.06 [SD=9.5] years and the mean of duration of diabetes was 9.7 [SD=7.3] years. Sixty-five [35%] had distress. Among the patients with distress, 55% were females and 64% had lower grade of education. Eighty patients were diagnosed as having Major Depressive Disorder. There was a relation between Emotional Burden subscale and age [P=0.004], employment status [P=0.03], and also diabetes duration [P=0.02]. The physician-related distress subscale was also related to the type of medication [P=0.009] and marital status [P=0.01]. It has been shown that the regimen-related distress subscale was also related to age [P=0.003] and duration of diabetes [P=0.005]. High prevalence rate of distress in the study highlights the significance of the need for identifying distress and also other mental health conditions in patients with diabetes in order to take collaborative care approaches

Neuroprotective effect of total and sequential extract of Scrophularia striata boiss. in rat cerebellar granule neurons following glutamate-induced neurotoxicity: an in-vitro study

Neuroprotective effect of the extract from aerial parts of Scrophularia striata Boiss [Scrophulariaceae] was investigated against glutamate-induced neurotoxicity on cultured rat pups Cerebellar Granule Neurons [CGNs]. CGNs from 8 days old Sprague-Dawley rat were prepared and cultured. The experiments were performed after 8 days in culture. The plant was collected from the northeastern part [Ruin region] of Iran and air-dried at room temperature. The total extract was prepared with maceration of prepared powder in ethanol 80% for three times. Sequential extracts were obtained using dried and powdered aerial parts with increasingly polar solvents: petroleum ether, chloroform, ethyl acetate and methanol 80% solution. Cultured cells were exposed to 125 micro M of glutamate for 12 h following a 24 h of incubation with test fractions at concentration of 10 mcg/mL. Morphological assay was performed using invert light microscope after fixation and staining with haematoxylin. Neuronal viability was measured using MTT assay. Statistical analysis was done using SPSS software. One way analysis of variance [ANOVA] was performed by Tukey post-hoc test. Values were considered statistically significant when p-value < = 0.05. Results of this study showed a significant neuroprotective activity of high polarity methanolic fraction of aerial parts of Scrophularia striata against glutamate-induced neurotoxicity in a dosedependent manner. Treatment with 10 mcg/mL of the fractions showed the best result

Primary Hydatid Cyst Posterior Triangle of Neck in a Child of 10 Years of Age.

A case of hydatid cyst involving posterior triangle of neck in a 10 year old male child is reported. Diagnosis was confirmed by MRI. Surgical excision of the cyst was done. Hydatid cyst in posterior triangle should be considered one of the possibilities in evaluating a cystic swelling in this region.

Congenital Descending Colonic Stenosis with Perforation of Transverse Colon in a Neonate: A Case Report.

Colonic atresia and stenosis are rare causes of intestinal obstruction in the infant. Only 10 cases have been reported in Literature since 1966 and only one late-onset case has been reported in Literature until now. We describe the case of a 3 day old baby presenting with abdominal distension, failure to pass meconium and vomiting. X-ray of the abdomen showed dilated gut loops. Exploratory laparotomy was performed. At the junction of descending and sigmoid colon a stenosis was found, laparotomy also revealed a perforation of transverse colon. Transverse colostomy and a mucous fistula of sigmoid colon was performed after resecting stenosing segment and colon distal to perforation site upto stenosing site. Diagnosis was confirmed on histopathology. Colostomy was close after six weaks with uneventful recovery. Considering both the Literature and our case, congenital colonic stenosis should be considered one of the rare differential diagnoses in a neonate presenting as complete or partial intestinal obstruction.

Effect of phase III cardiac rehabilitation and relaxation on the quality of life in patients with cardiac syndrome X

Cardiac syndrome X is a relatively common disorder, and still not much is known about the causative factors or its pathophysiology, which makes it difficult to cure. Due to its chronic nature and debilitating symptoms, many patients have significantly reduced quality of life [QOL].The purpose of this study was to assess the impact of phase III cardiac rehabilitation [CR] and relaxation on the QOL of patients. This research is a randomized clinical trial study. Forty eligible and consenting women [age 30-65 years] were randomly assigned to four groups. In the first group [n = 11], progressive muscle relaxation [PMR]; in the second group [n = 11], phase III CR; and in the third group [n = 11], PMR along with phase III CR were performed for 8 weeks at home. The fourth group [n = 7] was used as the control group. Short form of QOL questionnaire [SF 36] was used for data gathering.Data analysis was performed using X[2], Kruskal-Wallis, and rank sum difference tests. After phase III CR, relaxation, and combination of CR and relaxation, patients demonstrated improved QOL [P < 0.001]. The results of post test multiple comparisons showed that there were statistically significant differences between control and all intervention groups [P < 0.05]. There was also statistically significant difference between relaxation and combination of phase III CR and relaxation groups [P < 0.5]. An 8 week phase III CR program together with relaxation improved QOL of patients with cardiac syndrome X. We suggest phase III CR program together with relaxation as an effective treatment in these patients.

Medical management of diabetic retinopathy: an overview

Diabetes mellitus is a global health problem affecting 366 million people worldwide and its prevalence is growing rapidly. Diabetic eye disease is present in up to 25% of diabetic subjects. Diabetic retinopathy is a chronic complication of diabetes that can result in blindness. Generally, there are two stages of diabetic retinopathy, non-proliferative and proliferative. The longer a person has diabetes and the poorer metabolic control, the higher the chance of developing diabetic retinopathy. The majority of people with type 2 diabetes will ultimately develop diabetic retinopathy. Multifactorial therapy targeted to lifestyle modification and optional glycemic control reduces the risk. However, diabetic retinopathy develops or progresses with time. Primary [preventive] strategies include glycemic, lipid, and blood pressure control. Glycemic control effectively reduces the incidence of diabetic retinopathy. In additional, its effect on progression of diabetic retinopathy has been demonstrated in randomized clinical trials. Furthermore, tight control of blood pressure significantly reduces the progression of retinopathy and visual loss. However, the Action to Control Cardiovascular Risk in Diabetes [ACCORD] Eye Study Group has shown that intensive blood pressure control has no beneficial effect on reducing the rate of diabetic retinopathy in subjects with type 2 diabetes. Elevated serum lipids and dyslipidemias are associated with a higher risk of diabetic retinopathy. The beneficial effects of lipid-lowering agents on the progression of retinopathy have been reported. Intensive combination therapy for dyslipidemia has been shown to effectively reduce the rate of progression of diabetic retinopathy in type 2 diabetes. Secondary strategies are focused on various pathophysiologic approaches such as blockade of the renin angiotensin system [RAS], anti-vascular endothelial growth factor agents, somatostatin analogues, protein kinase inhibitors, and anti-inflammatory agents. The purpose of the current overview is to look into the medical management of diabetic retinopathy, and to explore the primary [preventive] measures as well as secondary strategies proposed to be effective in its medical management

Joubert’s Syndrome: A Case Report.

Joubert’s syndrome is an autosomal recessive congenital disorder having characteristic clinical features like hypotonia, ataxia, developmental delay and many neurological problems. Other variable features include retinal dystrophy, cystic kidney disease liver fibrosis etc. Treatment for Joubert syndrome is symptomatic and supportive. Infant stimulation and physical, occupational, and speech therapy may benefit some patients. Infants with abnormal breathing patterns should be monitored.

Manifestations of developmental dyslexia in monolingual Persian speaking students

Manifestations of dyslexia depend on language systems and scripts. This study explored the prevalence and clinical features of developmental dyslexia among monolingual Persian students and provided insights on mechanisms involved in reading Persian. To measure reading ability we developed a new instrument, Analysis of Persian Reading Ability, which had acceptable validity and reliability. A total of 1562 children aged 6 1/2 - 14 were randomly selected from a population of 109696 primary school students in the city of Qom, Iran. Using a variety of statistical and clinical criteria, 82 [5.2%] of the sample were classified as dyslexics. A detailed analysis of reading errors revealed eight types of errors related to three categories. The most frequent category in both dyslexic and the matched control group was phonological, followed by pragmatic and visual errors. The observed prevalence rate of dyslexia and reading error categories would suggest that Persian in vowel-free format is an opaque language and predominant use of a sub-lexical strategy is involved when reading Persian

Liver abscess in children: a 10-year single centre experience

Although liver abscess is more prevalent in developing countries than in developed countries, there is scant data about the characteristics of pediatric liver abscess in our region. We aimed to analyze the characteristics of pediatric liver abscess in our region and compare these with those of developed countries. The clinical features, laboratory, imaging, microbiologic findings, management strategy, and final outcome were extracted from the patients' records retrospectively. There were 18 cases of liver abscess including 16 pyogenic liver abscess, one amebic liver abscess and one candida liver abscess. Fever and abdominal pain were the most common clinical findings and leukocytosis was the most common laboratory finding. The most predisposing factors of liver abscess were immune deficiency, minor thalassemia. Origin of liver abscess was appendicitis in two patients, the rest were considered as cryptogenic. While one patient was treated with antibiotics alone, five cases were taken for open drainage, and 12 cases were treated with percutaneous aspiration. Percutaneous aspiration failed in two patients who were later taken for open drainage, with an overall mortality rate of 5.5%. The overall characteristics of liver abscess in children in our society are not so different from developed countries. However, in contradiction to case reported in developed countries, most cases of liver abscess were seen in healthy patients in our centre. Moreover, liver abscess was reported in our patients at a younger age and was more commonly seen in male children. Mortality rate was similar to that of developed countries

comparison between traditional yogurt and probiotic yogurt in non-inflammatory acute gastroenteritis

To compare the traditional yogurt and probiotic yogurt in improving acute noninflammatory gastroenteritis. A double blinded case-control clinical trial, performed in 100 patients aged 6 months to 12 years of age from October 2008 to September 2009 in Ghaem and Dr. Sheikh Hospitals in Mashhad, Iran. The patients were assigned to the following groups: the case group received a probiotic yoghurt and the control group received the ordinary yogurt. There were statistically significant differences between the case and control groups in reducing frequency of diarrhea in the first [p= 0.000], second [p=0.013], third [p=0.028], and fourth [p=0.022], therapy. Also, there was a significant difference [p=0.000] in discontinuation of diarrhea between the case and control groups. Acute non- inflammatory gastroenteritis improvement is accelerated by probiotic yogurt consumption

Experimental study on respiratory cryptosprodiosis

Cryptosporidiosis has a worldwide geographical and zoological distribution. Cryptosporidium baileyi oocysts were isolated from the bursa of Fabricius [BF] of 4 weeks-old of 100 broilers. Twenty five broiler chicks of 2 day old free from cryptosporidial infection were inoculated intratracheally at a dose of 1 x 10[6] chicks. Five chicks were sacrificed at 4[th], 8[th], 12[th], 16[th], and 20[th] day postinoculation. Selected tissues from bursa of Fabricius, cloaca, colon, caeci and tracheas were taken and examined directly by scraping technique for endogenous stages. The distribution of C. baileyi in different tissues in the case of intratracheal inoculation; trachea 23 [92%] chicks infected, bursa of Fabricius 21 [84%] chicks, Cloaca 5 [16%] chicks, Colon 1 [4%] chick and the caeci showing no infection. Daily examination of the intratracheal droppings inoculation was done at the 5[th] day and lasted for 18-20 days, the patent period

effect of clofibrate on neonatal hyperbilirubinemia in uncomplicated jaundice

Clofibrate has been used for several years as a hypolipidemic drug. Our aim was to study the effect of Clofibrate on neonatal hyperbilirubinemia in uncomplicated jaundice. This clinical trial study has been conducted on 90 normal term neonates who were admitted for uncomplicated jaundice in 17th-Shahrivar Children's Hospital of Guilan University of Medical Sciences from September 2005 to January 2006. The data included: age, sex, total and direct serum bilirubin, weight and duration of hospitalization. All data were analyzed by using statistical methods. All 90 infants enrolled in our study had received phototherapy. The infants were divided into Clofibrate group [G1] consisting of 26 boys [57.8%] and 19 girls [42.2%] and Control group with 24 boys [53.3%] and 21 girls [46.7%] [G2]. There were no statistically overt differences between the two groups regarding sex distribution, age, weight and total serum bilirubin level at admission. Mean values for total bilirubin of serum in Clofibrate group 12, 24, 36, and 48 hours after admission were significantly lower than those for Control group [P<0.00l]. The mean time needed for phototherapy in Clofibrate group [38.8] [20-48h] was significantly shorter than that in control group [68.7] [36-96h] [P<0.00l]. Clofibrate is effective and probably a safe drug for neonatal hyperbilirubinemia that can decrease the time needed for phototherapy and hospitalization, although further studies with a more precise and longer follow up is needed for proving its safety to be used routinely in the treatment of neonatal hyperbilirubinemia