Co-morbidités, infection a COVID-19 et pathologies chirurgicales. Cas du service de chirurgie viscérale et générale de l'hôpital Souro Sanou de Bobodioulasso (Burkina Faso). / Co-morbidities, covid-19 infection and surgical pathologies. Case of the department of visceral and general surgery of Souro Sanou hospital in Bobo-Dioulasso (Burkina Faso)

Le Burkina Faso a enregistré son premier cas de Covid-19 le 09 mars 2020 mais c'est au premier avril 2020 que le service de chirurgie générale et viscérale du Centre Hospitalier Universitaire Sourô SANOU (CHUSS) de Bobo-Dioulasso a enregistré son premier cas de COVID-19 et pathologie chirurgicale. En six mois, soit entre avril et septembre 2020, notre service a enregistré quatre cas, tous des malades de sexe masculin et testés positifs à la maladie de la Covid-19 après un prélèvement oropharyngé techniqué à l'aide de la trousse de RT-PCR Detection kit for 2019-n COV RNA (Da An Gene Co) et la Plate forme AriaMx (Real-Time PCR System).Les quatre malades étaient âgés respectivement de 63 ans, 70 ans, 60 ans et 66 ans et étaient pris en charge pour un traumatisme fermé du thorax, une gangrène de jambe, une tumeur vésicale et un adénocarcinome gastrique. Deux patients étaient décédés dans le service. Les deux autres avaient été transférés dans le centre régional spécialisé dans la prise en charge de la maladie COVID-19 avec une évolution favorable. L'impact de la Covid-19 en 2020 constaté dans le service de chirurgie générale et viscérale du CHUSS, a été une diminution de 82% des activités chirurgicales.

Burkina Faso recorded its first case of Covid-19 on March 09, 2020 but it was on April 1, 2020 that the general and visceral surgery department of the Center Hospitalier Universitaire Sourô SANOU (CHUSS) in Bobo-Dioulasso recorded its first case of COVID-19 and surgical pathology. From April to September 2020, our service recorded four cases, all male patients and tested positive for Covid-19 disease after an oropharyngeal sample performed using the RT- kit. PCR Detection kit for 2019-n COV RNA (Da An Gene Co) and the AriaMx (Real-Time PCR System) platform. The four patients were aged 63, 70, 60 and 66, respectively, and were being treated for blunt chest trauma, leg gangrene, bladder tumor and gastric adenocarcinoma. Two patients died in the ward. The other two had been transferred to the regional center specializing in the management of the COVID-19 with a favorable outcome. The impact of Covid-19 in 2020, observed in the general and visceral surgery department of the CHUSS, was a 82% decrease in surgical activities.

[ effect of L-tyrosine on thebaine production in cell suspension culture of iranian poppy [Papaver bracteatum]]

Background: Using of elicitors and different compounds in cell suspension culture is an effective strategy for enhancement and improvement of important secondary metabolites production in in vitro conditions

Objective: Evaluation of the effects of L-tyrosine and its combination with biological elicitors such as chitosan and salicylic acid on thebaine production in Iranian poppy cell suspension cultures at different days after elicitation

Methods: Different concentrations of L-tyrosine [1 and 2 mM] individually and in combination with chitosan [100 mg/L] and salicylic acid [50 mg/L] was applied on cell cultures, and then, pH and EC of medium, and also thebaine content of cells were measured on 2, 4 and 6 days after treatment

Results: The highest thebaine content of cells [42.30 mg/L] was obtained in 1 mM L-tyrosine on six days after treatment, which was significantly higher than the control. In addition, there was a relation between thebaine content of cells and pH and ECof culture medium. With increasing the thebaine content of cells, pH of medium was increased and EC of medium was decreased

Conclusion: Feeding of Iranian poppy cell suspension cultures with L-tyrosine [precursor of alkaloids biosynthesis] was improved thebaine production. So that, 1 mM L-tyrosine increased the thebaine content of cells up to 22.26-fold compared with control

Mental health status of Iranian university students using the- GHQ-28: a meta-analysis

Background and Aim: Mental health is one of the most important factors which can affect all aspects of human life. One of the questionnaires to screen the non-psychotic disorders is the general health questionnaire [GHQ]

This meta-analysis study aims to investigate the psychological disorders by using general health questionnaire [GHQ] in Iranian university students

Materials and Methods: We searched PubMed, Scopus, MAG Iran, Iranmedex, Medlib, SID and ISI data bases for GHQ, psychotic disorders and students as main key words

In order to assess homogeneity and publication bias we used I2 index and Egger test. CMA 2.0 software was used for data analysis

Results: We found 77 studies performed between 1991 and 2015 which included 44162 students. By using random models, we found a prevalence rate of 33% [95% CI: 0.295, 0.371] for mental disorders among Iranian students which showed an increasing trend [p<0.01]

Conclusion: In this study we found a high prevalence rate of mental disorders with an increasing trend in the Iranian students

[Effect of relaxation and attachment behaviors training on anxiety in first-time mothers in Shiraz city, 2010: a randomized clinical trial]

Anxiety of mother, as the first personality influencing child's mental health, is of great importance. Use of anxiety-reducing techniques for pregnant mothers plays an important role in decreasing maternal and child psychological problems. This study aimed to determine the effect of relaxation and attachment behaviors training on anxiety in first-time mothers. The present study was done as a clinical trial on 126 primigravida women [42 subjects as relaxation group, 42 subjects as attachment group and 42 subjects as control group] referred to Hafiz and Shushtari hospitals in Shiraz [2010]. Data were collected using personal data form and Spielberger Anxiety Inventory questionnaire. In addition to routine pregnancy care, four 90 minute sessions of attachment behaviors and relaxation training courses were held during 4 weeks [once a week]. The control group only received routine pregnancy care. Anxiety score before the intervention and at the end of the intervention were analyzed in all three groups. Data analysis was done using chi-square, Anova and paired t-test analysis, p<0.05 was considered statistically significant. In this study, the mean anxiety scores were not significantly different in the three groups before the intervention, but there were significant differences among three groups after the intervention [p<0.004]. There was a decrease in the mean anxiety score in the two experimental groups after the intervention, whereas there was an increase in the control group. The results of this study indicated that relaxation and attachment behaviors training could reduce anxiety in pregnant mothers

[Comparison of transplantation of human bone marrow mesenchymal stem cells and their derived neural like- progenitors to spinal cord injury rat model with injection]

The aim of the present study was to investigate transplantation of MSCs and their-derived Neural like progenitors [NLPs] into the spinal cord after injury and evaluate the survival, migration, differentiation properties of these cells in Rat spinal cord. NLPs were derived from MSCs [induced by bFGF [Fibroblast growth factor b], hEGF [Human Epidermal growth factor] and RA [Retinoic Acid]], and analyzed by flowcytometry and immuno fluorescence staining. MSCs and NLPs injected into model animals vein and collagen scaffold implanted into injured site. Behavioral testing was performed weekly for 5 weeks. Improvement of transplanted animals evaluated after 5 weeks. Unfortunately, Substantial changes were not observed among the rats after the transplantation. Immuno fluorescence staining analysis using human nuclei and BrdU antibodies confirmed survival and migration of hMSCs and NLPs into the injury site. Transplanted cells were found to adjacent segments located rostro-caudaly to the injury epicenter. Our findings indicate that hMSCs and NLPs couldn't facilitate recovery from spinal cord injury. However, these cells can express specific neuronal markers in injured site. There are many questions to be answered regarding this mechanism

Anemia and iron deficiency in adolescent school girls in Kavar urban area, southern Iran

Anemia is one of the most common public health problems especially in developing countries. We investigated the prevalence of anemia, iron deficiency anemia and related risk factors in adolescent school girls in Kavar urban area in southern Iran. A total of 363 adolescent school girls were evaluated by a cross sectional study. Socioeconomic demographic and related risk factors were obtained by a questionnaire. Hematological parameters and serum iron indices were measured. There were 21 cases of anemia [5.8%], 31 [8.5%] iron deficiency and 6 [1.7%] iron deficiency anemia. Most of anemic girls [85.7%] had mild anemia. MCV, TIBC, age, and BMI had statistically significant relationship with hemoglobin. Only parasites infestation in the last three months had a 6.83 times more risk of anemia than those without this history [95% CI, 1.66-28.11]. The prevalence of anemia and iron deficiency anemia in this study were substantially less than what reported in many other regions of Iran as well as other developing countries. It seems that related implemented strategies in the recent years have been successful. More especial attention to prevention of parasite infestation should be considered in this area

Effect of group reminiscence therapy on depression in older adults attending a day centre in Shiraz, southern Islamic Republic of Iran

The aim of this study was to examine the effectiveness of group reminiscence therapy on depression symptoms among elderly people attending a day centre in Shiraz, Islamic Republic of Iran. A sample of 49 people aged 60+ years participated in 6 group reminiscence sessions that were held twice weekly for a 3-week period and completed a Farsi version of the 15-item geriatric depression scale. Mean depression scores decreased significantly from 8.18 [SD 1.20] before the intervention to 6.73 [SD 1.20] immediately after it and 7.55 [SD 1.19] 1 month after the intervention. When analysed by demographic characteristics only marital status showed a statistically significant difference in depression scores comparing before and after the intervention

Reference values for Blood Pressure of healthy schoolchildren in Shiraz [Southern Iran] using Quantile Regression

The Reference values of systolic and diastolic Blood Pressure [BP] levels of school children aged 6-11 years by two different analytic strategies are presented and compared. From the cross-sectional study a total of 2064 children [52.3% boys and 47.7% girls] aged 6-11 years living in Shiraz [southern Iran] and considering their sex and height were used for this analysis. Polynomial Regression [PR] and Quantile Regression [QR] models based on Restricted Cubic Spline [RCS] were performed to calculate age and height specific reference ranges. To assess comparability of the two techniques, a chi-square goodness-of-fit within sex and age groups was preformed for each method. Both statistical methods generated reference values of systolic and diastolic BP using data from apparently healthy children. Analysis of data by two approaches reflected an increase in BP measurements with age and height in both sexes based on a nonlinear manner up to age 11. We found 50th and 95th percentile differences by two methods in BP level between the tallest and the shortest individuals, ranging from 2-7 mmHg. Using the QR model based on RCS offered the most flexible and better fit than PR model. The advantages of the QR led to a better adaptation of reference limits to the original data. This statistical approach might be preferable for the calculation of reference ranges in particular by non-normal distributed variables. Our results might help clinicians reach a consensus on the definition of hypertension in Iranian children living in Shiraz, south of Iran

Prevalence of dyspepsia and its correlation with demographic factors and lifestyle in Shiraz, Southern Iran

Dyspepsia is a common disorder that can present many clinical dilemmas in patient management. Although not life-threatening, the symptoms are long-lasting, interfere with daily activities and have a significant impact upon quality of life. The aim of this study was to determine prevalence of dyspepsia and its relationship with demographic and socioeconomic factors, and lifestyle in an apparently healthy population in Shiraz, southern Iran. In a population-based study, 1978 subjects aged 35 years or older were interviewed from April to September 2004. A questionnaire consisting of demographic factors, lifestyle data and gastrointestinal symptoms was completed for each participant. The validity and reliability of the questionnaire were determined. The prevalence of dyspepsia was 29.9%. The dyspeptic patients were classified as having ulcer-like [27.9%], dysmotility-like [26.2%] or unspecified dyspepsia [45.9%]. The prevalence was higher in females, water-pipe smokers, NSAIDs users, and in those with psychological distress, recurrent headache, anxiety, nightmares and past history of gastrointestinal disease. Dyspepsia had an inverse relationship with consumption of pickles, fruits and vegetables, and with duration of meal ingestion. Subjects with dyspepsia symptoms were more likely to restrict their diet, take herbal medicine, use over-the-counter drugs, consult with physicians and consume medication advised by their friends. This study reveals that dyspepsia has a high prevalence in Shiraz, southern Iran and is associated with several demographic factors, lifestyle and health-seeking behavior

Comparison of axillary, tympanic and rectal body temperatures using a covariate-adjusted receiver operating characteristic approach

Accurate temperature measurement is crucial in pediatric population. Before diagnostic tests are implemented in practice, it is suggested that their accuracy or ability to discriminate to be studied. The accuracy of a diagnostic test can be summarized in a Receiver Operating Characteristic [ROC] curve. This study was carried out to compare the accuracy of tympanic and axillary methods with rectal measurement in children less than 6 years old. A total of 220 pair of ears, axillaries, and rectal sites were used to determine the body temperature in patients aged between 3 months and 6 years, who referred to Emergency Department of Ali Asghar Hospital affiliated to Bushehr University of Medical Sciences. Rectal temperature [RT] was considered as gold standard. Fever was defined as RT >/= 38°C. RT, axillary, right and left tympanic temperature were measured. Measure agreement was assessed by covariate-adjusted ROC regression. By comparing the area under the curves in Hanely method and the results from ROC regression analysis, we found out a significant agreement among the three measuring techniques and none of them was more accurate than the others. None of these techniques [axillary, right and left tympanic] was more accurate than the others and it is better to use a technique that is more convenient, painless, and safer than rectal temperature. We also propose using a modified parametric distribution-free ROC estimator which is conceptually easy and is simple to implement with the existing softwares for comparing the accuracy of medical tests

Prevalence and quality of life in Qashqai migrating nomads with irritable bowel syndrome in southern Iran

Irritable Bowel Syndrome [IBS] is an important public health problem, owing both to its high prevalence and its impact on the quality of life. The purpose of this study was to investigate the prevalence and risk factors of IBS and its relationship to life style in Qashqai migrating nomads with a different lifestyle in Fars province, southern Iran. In summer 2006, 748 Qashqai migrating nomads aged 25 years or more were enrolled, using a multiple-stage stratified cluster random sampling method. A questionnaire consisting of demographic data and IBS symptoms was completed for each subject. For about 50% of them, SF 36 questionnaire was also completed. The prevalence rate of IBS was 11.8% and there was a close relationship between IBS and the life quality. The prevalence of IBS in Qashqai migrating nomads was higher than the urban population in the area with a close relationship to the life quality

Outcome and characteristics of patients on the liver transplant waiting list: Shiraz experience

The only curative therapy for end-stage liver disease is transplantation but due to a shortage of available donor livers the waiting list mortality is high. This study aimed to evaluate the outcome and characteristics of patients on the waiting list for liver transplantation in Shiraz, southern Iran during the period from April 2004 to March 2007. Medical records of all chronic liver disease patients >/= 14 years that were on the waiting list for liver transplantation at the Nemazee Hospital Organ Transplant Center during April 2004 to March 2007 were reviewed. Hospital records were used to retrieve demographic, clinical and laboratory data. Records of the referring gastroenterologists provided information about the etiology and complications of liver disease. The patients were followed at the end of the study period by clinic visits or telephone contact. There were 646 patients on the waiting list for liver transplant during April 2004 to March 2007. Hepatitis B was the most common etiology of liver disease [31.2%]. Of those on the waiting list, 144 patients 22.3%] underwent liver transplant and 166 [25.7%] died while waiting for a transplant. The mean waiting period for transplant was 6.6 months. Receiving a transplant was correlated with the etiology of liver disease and Rh blood group [p<0.05] but had no significant association with gender or ABO blood type. Among non-transplanted patients, survival was lower in those who had a history of encephalopathy, SBP or uncontrolled ascites and in patients with a Child-Turcotte-Puph [CTP] class C and/or a Model of End-stage Liver Disease [MELD] score >/= 15. Hepatitis B virus is the most common cause of end-stage chronic liver disease amongst patients on the waiting list for liver transplant in Shiraz, southern Iran. Patients with a MELD score >/= 15 particularly those with a history of SBP, hepatic encephalopathy or uncontrolled ascites are recommended for waiting list enrollment

Effect of CABG on p-wave dispersion and the relationship between AF and p-wave dispersion

Atrial fibrillation [AF] is a common complication after CABG. It is associated with doubling of mortality rate and increased incidence of CHF, MI, renal insufficiency, and stroke which prolongs hospital stay and is associated with increased rate of re-hospitalization. In this study we examined the effect of CABG on atrial electrophysiology as reflected by P-wave dispersion. A total of 197 consecutive patients undergoing elective CABG due to CAD were monitored for 4 days in hospital and their daily ECGs were obtained. .Differences in P-wave dispersions were compared between the patients who developed AF and those maintaining sinus rhythms. Post-operative AF occurred in 18.2% of patients, who showed statistically significant increase of P wave duration, in lead aVL of pre-op ECG [79.4 +/- 25.0 vs 70.1 +/- 22.4; P = 0.032]. In addition, P wave dispersion was significantly increased on first and third days of post-op period [77.2 +/- 22.0 vs 67.5 +/- 22.2; P=0.018] and [69.4 +/- 22.7 vs 61.1 +/- 20.3; P= 0.035] respectively, in those developing AF rhythm compared to patients remaining in sinus rhythm Our result indicates that P-wave dispersion is a risk factor for development of AF in patients undergoing CABG

effect of educational intervention on the knowledge and participation of administrative health personnel in colorectal cancer screening program at Shiraz university of medical sciences Shiraz 2003

Health care providers play an important role in planning and implementing policies to improve health behavior in the general population and increase participation in screening programs for early detection of cancer. This study was conducted to examine the effect of education on knowledge and the rate of participation of official administrative personnel with average risk for colorectal cancer, [age> 40 years], in colorectal cancer screening program at Shiraz University of Medical Sciences. In the first stage of the research, 156 subjects were selected based on predefined criteria using a questionnaire. They were then randomly divided in two groups, experimental and control groups with 78 subjects in each group. Demographic data, level of knowledge, willingness and perceived barriers to participate in screening programs were examined via two separate questionnaires. They were also asked to give stool samples to test for occult blood. In the second stage of the research, the intervention program, [based on health belief model] was conducted for the experimental group. An educational booklet and necessary information regarding colorectal cancer and screening programs were provided to them in two to three sessions. All subjects were asked to submit the stool samples to the laboratory for occult blood test; if a subject did not comply, a reminder was sent to him/her. In the third stage, knowkdge, [post-test] and the rate of subjects' participation in the screening program was analyzed. The results of the study revealed that most people are not interested in colorectal tests. Reasons given for disinclination for occult blood test and colonoscopy were lack of time and feeling healthy, respectively. Knowledge in both experimental and control groups regarding colorectal cancer was improved, this improvement was significantly higher in the experimental group, [p<0.001]. Furthermore, participation of the experimental group in the screening program was significantly higher than that of the control group [p<0.001]. Educating the subjects regarding colorectal cancer and sending reminders regarding stool tests may result in an increase in the knowledge and participation of subjects in screening programs for colorectal cancer

comparative study on temperature accuracy between tympanic, rectal, and axillary sites

A new method recently used for measuring the temperature is using tympanic thermometer. The aim of this study was to compare the accuracy of this method with rectal and axillary measurement in children less than 6 years old. A total of 220 pair ears, axillaries, and rectal sites were used to determine the body temperature in patients aged between 3 months to 6 years who referred to Emergency Department of Fateme Zahra Hospital affiliated to Bushehr University of Medical Sciences. Rectal temperature [RT] was considered as gold standard. Fever was defined as RT???38oC, axillary temperature [AT] ????37.2oC and tympanic temperature [TT] ????38oC. Correlation between rectal and tympanic temperature was statistically significant. The mean difference between RT and TT was 0.3oC and between RT and AT was 0.1oC. When cutoff point was considered 38oC for TT, the sensitivity was 46%, specificity was 97% and positive predictive value [PPV] and negative predictive value [NPV] were 92% and 72% respectively. ROC curve showed the best cutoff point for TT as 37oC, which increased the sensitivity to 92% and PPV to 0.98 but decreased the specificity to 90% and NPV to 0.57. Kappa test showed a good agreement rate between RT and TT. Age had significant effects on the TT/RT relationship. If the cut off point for TT is set at 38oC the sensitivity and NPV will be unacceptably low and a number of children with fever may be missed by screening with a tympanic thermometer. If the cutoff point is 37oC, the sensitivity and NPV will improve and TT can be used as a safe, easy, rapid, and accurate method in pediatrics

relationship between self-esteem, general health and academic achievement in students of Shiraz University of medical sciences

Controversial reports are available about the relationship between students' self-esteem, and their academic achievement and general health. Since these reports are mainly based on studies in high school students, this study was performed to determine the relationship between self-esteem, general health and academic achievement in students of Shiraz University of Medical Sciences. In a cross-sectional study, a sample of 512 students [168 male and 344 female] from 8 schools were randomly selected through multistage random sampling during autumn 2005. Data was gathered by demographic and achievement questionnaire, Copper-Smith inventory [for assessing self-esteem] and Goldberg Health Questionnaire [to assess general health]. The results were analyzed by SPSS-13 using descriptive statistics, Pearson correlation, t-test, ANOVA and multiple regressions. The mean score and standard deviation for self-esteem were 17.6 +/- 4.6 [out of 25], for general health were 20.9 +/- 4.13[out of 84] and average grade point was 15.6 +/- 1.6 [out of 20]. There were no significant correlations between self-esteem, and achievement. A significantly negative correlation between self-esteem and general health was seen [r = -0.59]. However, the difference between probationary and non-probationary students in terms of self-esteem and general health was significant. Predictive factors for grade point average were sex, residence, and being in probation. There was not a strong correlation between students' academic achievement and their general health and self-esteem, but, self-esteem and general health were correlated. It seems that students' academic achievement is influenced by other factors

[Reliability and validity of OSCE in evaluating clinical skills of nursing students]

Objective structured clinical examination [OSCE] is one of the preferable means of evaluating cognitive, emotional and psychomotor aspects of nursing students. The present study was designed to determine the reliability and validity of OSCE in evaluating clinical skills of nursing students. For this descriptive study, 10 different skills of nursing students were selected. Then, 37 students performed these skills at 10 different OSCE stations, during which two experienced inspectors evaluated their performance. Finally, the correlation between OSCE scores and the mean theoretical and clinical performance scores of students was calculated. Meanwhile, the correlation between the total OSCE scores with OSCE score of each station was determined. Inspectors' reliability [correlation between scores reported by inspectors at each station] was also calculated. The correlation coefficient of OSCE scores and mean theoretical and clinical performance scores were 0.38 [p=0.031] and 0.52 [p=0.005], respectively. Correlation coefficient of inspectors' reliability was in a range of 0.38-0.95. OSCE is strongly suggested as a reliable and valid means of evaluating nursing students' clinical skills

Some risk factors of obesity in rural women of Zarrindasht: using linear regression odds ratio

Obesity is becoming a world wide health problem, affecting all groups of age, sex and economy. This important problem is a major risk factor for some diseases. The prevalence of obesity not has been well studied in the rural areas. The purpose of this study was to determine the prevalence of obesity and some of the relevant risk factors in women of Zarrindasht rural areas using the odds ratio estimated from the regression approach. In a cross-sectional study in 2005, a number of 920 women infertility age from rural areas of Zarrin-Dasht, at eastern part of Pars province were selected by random multi stage sampling. Correlation ship between BMI and some variables including age, education level, number of children, socio-economic status and mean duration of breast feeding were evaluate. The age and education level of their husbands were also considerved. Odds ratio [OR] was using both logistic regression approach and the linear regression procedure [without dichotomizing]. BMI of 25 or higher was considered as over weight or obesity. The studied women aged between 17 to 47 years old and the prevalence of over weight [25/= 30] was 30% and 14% respectively. In both statistical models, significant associations were found among husbands education, number of children, socio-economic status and increasing risk of obesity. Precision of linear regression approach in estimating OR was higher than that of logistic regression. It is concluded that, similar to the urban areas, the obesity is highly prevalent in the rural population. This can potentially affect the health of rural community and needs consideration. Prevention and control of obesity are recommended to be as of health program priorities

[Outcome of multiple usages of disposable insulin syringes in insulin dependent patients referring to Shahid Motahari Clinic in Shiraz]

In spite of a high risk of infection, multiple usages of disposable insulin syringes among diabetic patients is quite common. The present study was designed to assess the outcome of multiple usages of disposable insulin syringes in insulin dependent patients referring to Shahid Motahari clinic in Shiraz. For this descriptive study, through a random sampling method, 117 patients were selected. Initial data were obtained by a questionnaire and the patients were asked to deliver their syringes following their last injection to be examined by microbiological tests. The injection site was also examined for the evidence of infection within a 24-hour period. In the next stage, 30 patients were randomly chosen among those who had used each syringe more than once and another reused syringe was received from them 1 week later. However, the second syringes were tested in microbiology lab 24 hours after the last injection. Totally, 82.1% of patients used their syringes more than once. No infection was detected at the site of injection, however, microbial contamination was found in four syringes and in 11 needles. 2 of these syringes were used just once. Syringe and needle contamination was found more commonly among those who did not use alcohol [for injection area disinfections] [p<0.02]. Syringe and needle contamination was not significantly associated with sex, frequency of reuse, insulin type, hygiene, place and method of keeping syringes between two injections. The cultured pathogens were as follow: staphylococcus aureus in 6, staphylococcus epidermidis in 2, non-entrococci in 3, and diphtheroid, bacillus subtilis, entrococci and anaerobic gram positive bacillus, each in one. The risk of syringe and needle contamination is more when disinfecting methods and disinfectants are not used. Furthermore, multiple usage of the insulin syringes in this study, did not lead to injection site infection