Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial

PURPOSE

Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles.

METHODS

Twenty-four patients (35-65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor.

RESULTS

The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01).

CONCLUSIONS

Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1IMPLICATION FOR REHABILITATIONUpper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily livingApplying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions.

The effect of perturbation training with and without applying the dry needling on leg muscles in patients with chronic ankle sprain

INTRODUCTION

Ankle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure.

OBJECTIVE

Investigate the added value of dry needling into perturbation training protocol for chronic ankle sprain.

DESIGN

Randomized clinical trial; assessor-blind; before and after comparison.

SETTING

Treatment of patients referred to the institutional rehabilitation clinics.

MAIN OUTCOME MEASURE(S)

Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool.

METHODS

Twenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment.

RESULTS

Data Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05).

CONCLUSION

The findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability.

The effect of varying concentrations of chicken plasma egg yolk and glycerol on the viability of canine sperm following short and long-term preservation

Background

Plasma egg yolk (PEY), due to simple preparation and easier access, could be a suitable alternative to raw egg yolk for preserving canine semen.

Aims

The present study investigated suitable concentrations of PEY and glycerol for preservation of canine semen.

Methods

Semen was collected by digital manipulation (seven replicates from four dogs). Following initial raw semen evaluation, the semen was diluted in a tris-based extender supplemented with varying concentrations of chicken PEY (0, 20, and 40% v/v) and glycerol (3%; v/v). After cooling the specimen to 4°C within 1 h, the specimens were diluted with an equal volume of freezing extender consisting of similar concentrations of chicken PEY and 0 and 7% glycerol to reach the final glycerol concentration of 1.5 and 5% for short-term storage of canine semen. Samples with different concentrations of PEY and 5% glycerol were frozen. The sperm viability parameters including total motility, progressive forward motility, plasma membrane integrity, and live percentage of sperm were assessed following short and long-term storage.

Results

Sperm viability parameters of semen extended in an extender supplemented with 20 or 40% chicken PEY with either 1.5 or 5% glycerol remained superior until 72 h after semen collection compared to the specimen that did not receive any PEY (P<0.05). Post-thaw sperm viability was also greater in samples extended in extender supplemented with either 20 or 40% PEY compared to 0% PEY.

Conclusion

Tris-based extender supplemented with either 20% chicken PEY could be suitable for short and long-term preservation of canine semen.

Predicting evaporation with optimized artificial neural network using multi-objective salp swarm algorithm

Evaporation is a crucial component to be established in agriculture management and water engineering. Evaporation prediction is thus an essential issue for modeling researchers. In this study, the multilayer perceptron (MLP) was used for predicting daily evaporation. MLP model is as one of the famous ANN models with multilayers for predicting different target variables. A new strategy was used to enhance the accuracy of the MLP model. Three multi-objective algorithms, namely, the multi-objective salp swarm algorithm (MOSSA), the multi-objective crow algorithm (MOCA), and the multi-objective particle swarm optimization (MOPSO), were respectively and separately coupled to the MLP model for determining the model parameters, the best input combination, and the best activation function. In this study, three stations in Malaysia, namely, the Muadzam Shah (MS), the Kuala Terengganu (KT), and the Kuantan (KU), were selected for the prediction of the respective daily evaporation. The spacing (SP) and maximum spread (MS) indices were used to evaluate the quality of generated Pareto front (PF) by the algorithms. The lower SP and higher MS showed better PF for the models. It was observed that the MOSSA had higher MS and lower SP than the other algorithms, at all stations. The root means square error (RMSE), mean absolute error (MAE), percent bias (PBIAS), and Nash Sutcliffe efficiency (NSE) quantifiers were used to compare the ability of the models with each other. The MLP-MOSSA had reduced RMSE compared to the MLP-MOCA, MLP-MOPSO, and MLP models by 18%, 25%, and 35%, respectively, at the MS station. The MAE of the MLP-MOSSA was 2.7%, 4.1%, and 26%, respectively lower than those of the MLP-MOCA, MLP-MOPSO, and MLP models at the KU station. The MLP-MOSSA showed lower MAE than the MLP-MOCA, MLP-MOPSO, and MLP models by 16%, 18%, and 19%, respectively, at the KT station. An uncertainty analysis was performed based on the input and parameter uncertainty. The results indicated that the MLP-MOSSA had the lowest uncertainty among the models. Also, the input uncertainty was lower than the parameter uncertainty. The general results indicated that the MLP-MOSSA had the high efficiency for predicting evaporation.

A hybrid novel SVM model for predicting CO2 emissions using Multiobjective Seagull Optimization

The agricultural sector is one of the most important sources of CO₂ emissions. Thus, the current study predicted CO₂ emissions based on data from the agricultural sectors of 25 provinces in Iran. The gross domestic product (GDP), the square of the GDP (GDP²), energy use, and income inequality (Gini index) were used as the inputs. The study used support vector machine (SVM) models to predict CO2 emissions. Multiobjective algorithms (MOAs), such as the seagull optimization algorithm (MOSOA), salp swarm algorithm (MOSSA), bat algorithm (MOBA), and particle swarm optimization (MOPSO) algorithm, were used to perform three important tasks for improving the SVM models. Additionally, an inclusive multiple model (IMM) used the outputs of the MOSOA, MOSSA, MOBA, and MOPSO algorithms as the inputs for predicting CO₂ emissions. It was observed that the best kernel function based on the SVM-MOSOA was the radial function. Additionally, the best input combination used all the gross domestic product (GDP), squared GDP (GDP²), energy use, and income inequality (Gini index) inputs. The results indicated that the quality of the obtained Pareto front based on the MOSOA was better than those of the other algorithms. Regarding the obtained results, the IMM model decreased the mean absolute errors of the SVM-MOSOA, SVM-MOSSA, SVM-MOBA, and SVM-PSO models by 24, 31, 69, and 76%, respectively, during the training stage. The current study showed that the IMM model was the best model for predicting CO₂ emissions.

Suspended sediment load prediction based on soft computing models and Black Widow Optimization Algorithm using an enhanced gamma test

The suspended sediment load (SSL) prediction is one of the most important issues in water engineering. In this article, the adaptive neuro-fuzzy interface system (ANFIS) and support vector machine (SVM) were used to estimate the SLL of two main tributaries of the Telar River placed in the north of Iran. The main Telar River had two main tributaries, namely, the Telar and the Kasilian. A new evolutionary algorithm, namely, the black widow optimization algorithm (BWOA), was used to enhance the precision of the ANFIS and SVM models for predicting daily SSL. The lagged rainfall, temperature, discharge, and SSL were used as the inputs to the models. The present study used a new hybrid Gamma test to determine the best input scenario. In the next step, the best input combination was determined based on the gamma value. In this research, the abilities of the ANFIS-BWOA and SVM-BWOA were benchmarked with the ANFIS-bat algorithm (BA), SVM-BA, SVM-particle swarm optimization (PSO), and ANFIS-PSO. The mean absolute error (MAE) of ANFIS-BWOA was 0.40%, 2.2%, and 2.5% lower than those of ANFIS-BA, ANFIS-PSO, and ANFIS models in the training level for Telar River. It was concluded that the ANFIS-BWOA had the highest value of R² among other models in the Telar River. The MAE of the ANFIS-BWOA, SVM-BWOA, SVM-PSO, SVM-BA, and SVM models were 899.12 (Ton/day), 934.23 (Ton/day), 987.12 (Ton/day), 976.12, and 989.12 (Ton/day), respectively, in the testing level for the Kasilian River. An uncertainty analysis was used to investigate the effect of uncertainty of the inputs (first scenario) and the model parameters (the second scenario) on the accuracy of models. It was observed that the input uncertainty higher than the parameter uncertainty.

Spatiotemporal dynamics of ecosystem services provision in a degraded ecosystem: A systematic assessment in the Lake Urmia basin, Iran

Lake Urmia has experienced severe environmental degradation, mainly characterized by the enormous reduction of its surface area and water level. This issue has been mainly attributed to land-use and land-cover changes, in particular related to agricultural expansion and intensification. In this study, we used the DPSIR framework (D: driving forces, P: pressures, S: states, I: impacts, and R: responses) to systematically describe the ecosystem service dynamics related to anthropogenic activities and climatic parameters in the region. We reviewed the literature and used remote sensing, agricultural, climatic and hydrological data together with expert knowledge to assess the main driving forces and pressures, resulting land-use transitions and their spatiotemporal impacts on ecosystem services and biodiversity using a matrix-based assessment approach. We identified population growth, economic incentives and climate change as the most important driving forces, leading to altered agricultural activities, numerous dam constructions and droughts. Since 1987 cropland areas doubled at the expense of bare soils and natural vegetation, the lake hast lost more than half of its surface area, urban and freshwater areas increased threefold and by 50%, respectively. This favored crop and freshwater provision, while all other ecosystem services remained nearly constant or decreased, though spatial patterns were heterogeneous. For example, regulating and cultural services, and biodiversity mainly decreased at the shorelines of the lake, while provisioning services increased along the major rivers and close to cities. To address the land-use transitions with the most profound impact on ecosystem service provision, we recommend the following measures: increase the water supply to the lake, reduce cropland expansion, manage existing croplands more sustainably and protect natural vegetation. Our study provides a comprehensive overview of the regional ecosystem service dynamics and a valuable baseline for future research and environmental management in the basin.

Fingolimod and changes in hematocrit, hemoglobin and red blood cells of patients with multiple sclerosis

INTRODUCTION

Fingolimod is the first oral drug approved by Food and Drug Administration (FDA) of United States for treating patients with relapsing-remitting multiple sclerosis (RRMS). Fingolimod acts by immunomodulation but there are still much remained about its different effects.

OBJECTIVES

The aim of this study was to evaluate the changes in hematocrit (Hct), hemoglobin (Hb), and red blood cells (RBC) of patients with MS under treatments with fingolimod.

METHODS

A total number of 66 MS patients were included to our study based on certain exclusion criteria and eligibility for fingolimod oral treatment. Hct, Hb, and RBC were measured for each patient before drug administrations. Patients were treated with Fingolimod. 5 mg daily and after three months of treatments, measurements of Hct, Hb, and RBC were performed. Data were analyzed using SPSS software version 24.

RESULTS

Amounts of Hct, Hb, and RBC were significantly decreased in this patient cohort. Hematocrit was decreased in all patients. Hemoglobin levels were significantly decreased in the female cohorts. Such decreases for male patients were insignificant. Red blood cell counts were also significantly decreased in patients.

CONCLUSION

Accumulating line of evidence had surveys on different side effects of fngolimod but here we indicated that fingolimod will also decrease amounts of Hct, Hb, and RBC which could result further problems in patients susceptible to other diseases.

A Study on Radiation Dose Received by Patients during Extracorporeal Shock Wave Lithotripsy

BACKGROUND

Extracorporeal shock wave lithotripsy (ESWL) is considered as the method of choice for treatment of most stone diseases. The present study aims to evaluate radiation dose received by patients undergoing ESWL.

METHODS

In total, 46 patients from both genders were referred to the Shohadaye Ashayer hospital of Khorramabad, Iran and were included in the present study. Patients were positioned in anteroposterior (AP) projection and along 30° anterior oblique (AO) projection upon the X-ray fluoroscopy table and exposures were conducted. Thermoluminescent dosimeters (TLDs) were used for radiation dose measurements. To evaluate the entrance surface dose (ESD), each TLD chip was taped on back of patient at the entrance surfaces of the X-ray beam.

RESULTS

The mean number of stones in each patient was 1.4. The stone sizes ranged from 7 to 29 mm, and a mean of 3200 pulses were need for each patient. The mean ESD in the postero-anterior (PA) and oblique X-ray beam entrance were obtained at 12.04 and 68.84 mGy, respectively. There was linear correlation between patient dose with fluoroscopy time, tube current (mA), tube potential (kVp) and patient position (P < 0.001); however, we found no strong correlation between patient dose with patient body mass (P = 0.837), number of shock wave pulses (P = 0.089), stone size (P = 0.773) and locations (P = 0.463).

CONCLUSION

The data obtained in the current study are comparable with information available in the literature. They emphasized that ESWL exposes patients to much more radiation compared to those from conventional radiography and is in the range of computed tomography (CT) procedures. Therefore, following safety guidelines is recommended.

22 Comparing Three Extenders: Hashi, Green Buffer and INRA 96, for Chilled Storage of Bactrian Camel Semen

Semen preservation remains challenging in the camel industry. The objective of the present study was to compare 3 different extenders for chilled storage of Bactrian camel semen. Semen (n = 9 ejaculates) was collected from camel bulls (n = 2) manually using artificial vagina. Good neat semen, as far as mass vibration concerns, was equally distributed into 3 double-wall vessels filled with 35°C water. The 3 extenders used in the present study were Hashi, Green buffer (IMV, L’Aigle, France), and INRA 96 (IMV). The Hashi extender consisted of Tris, 2.6%; citric acid, 1.35%; glucose, 0.9%; fructose, 0.9%; penicillin G sodium, 1000 IU mL−1; streptomycin sulfate, 1000 mg mL−1 supplemented with 20% plasma egg yolk and 20% camel skim milk; osmolality of 330 and pH of 6.9). Green buffer was supplemented with 20% plasma egg yolk (osmolality of 335 and pH of 6.9). The osmolality and pH of INRA 96 were 310 and 7, respectively. Extenders at a ratio of 1:3 were added to semen followed by pipetting 10 times with an automatic pipettor. The water-jacketed extended specimen was covered with foam and transferred to individual vaccine carrier equipped with 4 ice packs. This system of cooling not only allows the specimen to cool down slowly and reach 4°C after 7 h, but also reduces the viscosity of camel semen. The assessment was carried out 7 and 24 h after semen dilution, when the specimen reached 4°C. Semen viability parameters were assessed after short-term semen preservation in different extenders. Total motility and progressive forward motility were examined subjectively by single operator using Sperm Track (ISAS, Proiser, Spain) after diluting the specimen to achieve 25 × 106 sperm mL−1. Live percentage of sperm was estimated using Eosin B Fast Green staining method. Plasma membrane integrity was assessed using the hypo-osmotic swelling (HOS) test. Following arcsin transformation, data were analysed by GLM procedure followed by Tukey test in SAS (SAS Institute Inc., Cary, NC, USA). At 7 and 24 h, there were no differences among the 3 extenders in total motility of sperm (Hashi: 73 and 67.4%; Green buffer: 71.6 and 62.1%; INRA 96: 70 and 66.2%; P > 0.05), live percentage of sperm (Hashi: 76 and 73%; Green buffer: 70.5 and 65.6%; INRA 96: 77.8 and 70.7%; P > 0.05), or HOS test (Hashi: 52.4 and 45.2%; Green buffer: 49.6 and 40.6%; INRA 96: 57.3 and 51.1%; P > 0.05). However, at the same times, progressive forward motility was similar between Hashi (47.7 and 28.6%) and Green buffer (40 and 23.5%; P > 0.05) but was different between Hashi and INRA 96 (23.6 and 16.7%; P < 0.05). In conclusion, Hashi and Green buffer could be considered suitable extenders to preserve Bactrian camel semen under chilled condition. Further studies with a larger number of bulls and ejaculates are warranted.

Evaluation of non-motor symptoms and their impact on quality of life in patients with Parkinson's disease, Isfahan, Iran

Background: Parkinson's disease (PD) is diagnosed on the basis of motor symptoms, but non-motor symptoms (NMS) have high prevalence in PD and often antecede motor symptoms for years and cause severe disability. This study was conducted to determine the prevalence of NMS in patients with PD. Methods: This cross-sectional study was performed in Isfahan, Iran, on patients with PD. The prevalence of NMS was evaluated by the NMS questionnaire, the NMS scale, and Parkinson's disease questionnaire-39 (PDQ-39). The Mini-Mental Status Examination (MMSE) was used for assessing cognition. Results: A total of 81 patients, including 60 men and 21 women, were recruited for this study. The prevalence of NMS was 100%, and the most commonly reported symptom was fatigue (87.7%); there was a strong correlation between NMS and the quality of life (QOL) of patients with PD (P < 0.001). Conclusion: This study showed that NMS are highly prevalent in the PD population and adversely affect QOL in these patients. Early diagnosis and treatment can improve QOL and can help in disability management of patients with PD.

Comparing three superovulation protocols in dromedary camels: FSH, eCG-FSH and hMG

The objective of this study was to compare three superovulation protocols in dromedary camels. Follicular waves of dromedary camel donors (n=6) were synchronized using two GnRH injections. Superovulation was initiated 2 days after the second injection (day 0 of experiment). The experiment was conducted using change over design, where all females received three superovulation treatments one after the other with a resting period of one month in between. Superovulation was carried out for all donors using 390 mg FSH, 1000 IU eCG and 330 mg FSH, or 16.5 ampule hMG (75 i.u. FSH and 75 i.u. LH per ampoule). FSH and hMG were injected twice daily, indecreasing doses, over 5.5 days. Thirty-six h after the last FSH or hMG injection, donors were mated once and received an intravenous injection of the GnRH analogue. The diameter and number of ovarian follicles ≥4 mm on day 4 after superovulation and the total number of corpora lutea and follicles ≥9 mm on day 7.5 after mating were evaluated by ultrasound examinations. No significant differences were found between the total number of corpora lutea among FSH (13.8 ± 2.65), eCG-FSH (15 ± 2.60) and hMG (10.8 ± 2.30) and the number of expanded hatched blastocysts in FSH (5.7 ± 2.32), eCG-FSH (8.8 ± 2.10) and hMG (5.8 ± 2.40) treated donors. This study showed that all three superovulatory protocols could be used successfully and interchangeably in dromedary camels.

Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain

OBJECTIVE

The aim of this study was to investigate the comparison of massage therapy and routine physical therapy on patients with sub acute and chronic nonspecific low back pain.

METHODS AND MATERIALS

Thirty volunteer female subjects with a sub acute or chronic nonspecific low back pain were randomly enrolled in two groups, massage therapy and routine physical therapy. After massage application, the hamstring and paravertebral muscles stretching and also stabilizing exercises were prescribed. In the routine physical therapy group, TENS, US and vibrator were used besides exercises. Pain intensity according to Numerical Rating Scale, functional disability level in accordance to Oswestry Disability Index, and modified Schober test, for measurement of flexion range of motion, before and after ten sessions of treatment were used to evaluate the effectiveness of the treatment.

RESULTS

Pain intensity, Oswestry Disability Index and flexion range of motion had shown significant differences before and after intervention in both groups (p<0.001). The statistical analysis revealed that the massage therapy had significantly improved the pain intensity and Oswestry Disability Index compared to routine physical therapy (p=0.015, p=0.013 respectively), but the range of motion changes were not significant between two groups (p=1.00).

CONCLUSION

It can be concluded that both massage therapy and routine physical therapy are useful for sub acute and chronic nonspecific low back pain treatment especially if accompanied with exercise. However, massage is more effective than other electrotherapy modalities, and it can be used alone or with electrotherapy for the treatment of patients with low back pain.

Protective effects of Cornus mas fruit extract on carbon tetrachloride induced nephrotoxicity in rats

Oxidative damage is implicated in the pathogenesis of kidney injury. Cornus mas is used for in renal aliments traditionally in Iran. The present study was aimed to investigate the antioxidant activity of C. mas fruit extract (CMFE) on carbon tetrachloride (CCl₄) treated oxidative stress in Wistar albino rats. Forty two male albino rats were divided into seven groups. Group I served as a sham; Group II served as a normal control; Group III served as a toxic control, with CCl₄ (1 ml/kg body weight; 80% in olive oil); Groups IV and V received CMFE at doses of 300 and 700 mg/kg before CCl₄ injection; Groups VI and VII received extract at same doses orally at 2, 6, 12, 24 and 48 h after CCl₄ intoxication. CCl₄ injection produced a significant rise in serum markers of oxidative stress and lipid peroxidation product malondialdehyde along with the reduction of antioxidant enzymes such as superoxide dismuta, catalase and glutathion peroxidase. Serum creatinine, urea and uric acid concentrations were increased whereas level of protein and albumin were reduced. Treatment of rats with different doses of fruit extract (300 and 700 mg/kg) significantly (P < 0.05) ameliorated the alterations induced with CCl₄ in lipid peroxidation, antioxidant defenses, biochemical and renal lesions. Based on these results, we conclude that CMFE protects kidney from oxidative stress induced by CCl₄.

Experience of cyclone Gonu in the Islamic Republic of Iran: lessons learned

Gonu, the second tropical cyclone of the 2007 northern Indian ocean cyclone season, affected Oman, Pakistan, the United Arab Emirates and the Islamic Republic of Iran. This report examines the effects of cyclone Gonu in the Islamic Republic of Iran where it approached on its path on 6 June 2007 and reviews the actions taken before, during and after the cyclone. The incident highlighted the need for a special protocol to be prepared for all types of natural disasters. Responsible organizations should train their personnel according to the prepared protocols and service packages. Among the important lessons learned were the need for early warning, proper community involvement, access to essential data for risk analysis, special attention to safety of infrastructures, coordination and command integrity.

The role of fibular fixation in the treatment of tibia diaphysis distal third fractures

INTRODUCTION

Combined fractures of the distal third of tibia diaphysis and fibula diaphysis are a common orthopedic injury. There is an ongoing debate about the necessity of fibular fixation when associated to distal third tibial fracture. This study aims at evaluating the role of fibular fixation in the treatment of distal third tibial fractures.

HYPOTHESIS

We hypothesized that fixation of the fibula increases the stability of fixation in distal third tibial and fibular fractures.

MATERIALS AND METHODS

In a randomized clinical trial, 53 patients with concomitant fractures of tibia and ipsilateral fibula at distal third level were recruited in this study during a 23-month period. Patients were randomized in two groups: patients with fibular fixation (case group) and without fibular fixation (control group). The patients were followed up for at least 6 months postoperatively.

RESULTS

There were seven cases exhibiting malalignment on immediate postoperative radiographs. Six of them were in group II (control group) and one was in group I (case group) (P=0.084). We didn't find nonunion in group I and we found three patients in group II (P=0.141). Infection was one in group I and two in group II on gustillo II injuries (P=0.516).

CONCLUSION

Despite its low count of patients, our study didn't show any advantage to fix the fibula fracture associated to distal third of tibia diaphysis fracture. It didn't show either an increase of complication after fibula open reduction and internal fixation.

LEVEL OF EVIDENCE

Level III. Randomized prospective study.

Assessment and outcome of 496 penetrating gastrointestinal warfare injuries

AIM

The abdominal viscera are among the most vulnerable organs of the body to penetrating trauma. Proper management of such trauma in war victims at the first-line hospital where these victims are first seen is of paramount importance. We reviewed medical records of war victims suffering small bowel and colorectal injuries treated at first, second and third-line hospitals during the Iraq-Iran War (1980-88) to assess surgical outcomes.

METHODS

The medical records of 496 Iranian war victims suffering penetrating gastrointestinal (GI) injuries treated at first, second and third-line (tertiary) hospitals, a total of 19 centres, were reviewed. Laparotomy had been performed at the 1st line hospitals for all patients who had an acute abdomen, whose wounds violated the peritoneum or whose abdominal radiographs showed air or shrapnel in the abdominal cavity. Stable patients were transferred from first-line to second-line or from second line to tertiary hospitals postoperatively. The treatments, complications and patient outcomes were documented and analyzed.

RESULTS

There were 496 patients; 145, 220 and 131 victims underwent laparotomy for GI injuries at first, second and third-line hospitals respectively. The small intestine and colon respectively were the most prevalent abdominal organs damaged. Those first treated for GI injuries at front-line hospitals (145 victims) had more serious conditions and could not be transferred prior to surgery and presented a higher prevalence of complications and mortality. Overall mortality from GI surgery was 3.6% (18 patients). Eleven patients (7.5%) whose first GI operation was performed at frontline hospitals and 7 patients (3.2%) who underwent their first surgical operation at second-line hospitals died. The most common reason for these deaths was complications relating to the gastrointestinal operation such as anastomotic leak. Six missed injuries were seen at the frontline and one at second line hospitals. There were no deaths at the 3rd line hospitals.

CONCLUSION

Penetrating abdominal injuries were common in Iranian victims of war often causing multiple organ injuries. The colon and small intestine were the more commonly injured organs and carried the most postoperative complications. Mortality at 1st line hospitals was more than double that of 2nd line hospitals; the complication rate was also greater as was the number of missed injuries. Adherence to the standard surgical protocols, prompt evaluation, proper triage and management are factors which may lower patient morbidity and complications.

The Outcome of Diverticulosis in Kidney Recipients With Polycystic Kidney Disease

INTRODUCTION

Diverticulosis is a common finding in autosomal-dominant polycystic kidney disease (ADPKD). To avoid the serious complications of diverticulosis after kidney transplantation, some policies have recommended aggressive actions, such as elective colectomy. These policies are not widely agreed upon. This controversy led us to investigate the serious complications and the outcome of diverticulosis in ADPKD kidney recipients to see whether such therapies are justified.

MATERIALS AND METHODS

From 2002 to 2006, we followed 18 ADPKD kidney recipient patients with barium enema-documented diverticulosis. All subjects were asymptomatic for diverticulosis at the time of transplantation. The mean value +/- SD of follow-up duration was 25.4 +/- 28.5 months. We documented demographic data, familial history of ADPKD, barium enema findings, and complications as well as graft and patient survivals.

RESULTS

Hepatic flexure was the most prevalent site for diverticula. The mean (SD) of diverticular count was 6 +/- 5.1. Patients with a familial history of ADPKD showed a higher number of diverticular (P=.01). Diverticulitis occurred in three patients, all of whom died.

CONCLUSION

Diverticulitis is a fatal and not rare complication in ADPKD patients. The rate of complications in our study was similar to previous findings, but we observed serious complications even among patients asymptomatic at the time of transplantation. The decision to take aggressive action such as elective colectomy is still a matter of debate that needs further evaluation.

[Costal echinococcosis. Report of one case and review of the literature (author's transl)]

Following the report of a case of costal echinococcosis, a review of the published literature showed that 32 identical cases have been the subject of publications in the Occident. A further 6 cases were found in the records of the University Hospitals in Teheran, which brings the total to 39 published cases, including our patient, known at the present time. It is important to make the diagnosis in these cases so that the surgeon can take the necessary precautions to avoid the anaphylactic shock which can follow dissemination of the parasite.

Prevention of hepatitis type B with specific immune serum globulin

In order to evaluate the preventive value of specific immune serum globulin against hepatitis type B, we have used this immune globulin in required doses in 12 patients (10 with AU antigen negative and 2 with AU antigen positive) with chronic renal failure who required maintenance hemodialysis for a period of 15 months, and we were able to prevent hepatitis type B in our dialysis patients.