Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Management of Blunt Trauma to the Spleen (Part 1)
79
94
EN
Seyed Abbas
Banani
Spleen is the most frequent solid organ to be injured in blunt abdominal trauma. Considering its important role in providing immunity and preventing infection by a variety of mechanisms, every attempt should be made, if possible, to salvage the traumatized spleen at any age particularly in children. After primary resuscitation, mandatory requirements for non-operative management include absence of homodynamic instability, lack of associated major organ injury, admission in the intensive care unit for high-grade splenic injury and in the ward for milder types with close monitoring. About two third of the patients would respond to non-operative management. In most patients, failure of non-operative measures usually occur within 12 hours of management. Determinant role of abdominal sonography or computed tomography, and in selected cases, diagnostic peritoneal lavage, for appropriate decision cannot be overemphasized. However, the high status of clinical judgment would not be replaced by any paraclinical investigations. When operation is unavoidable, if possible, spleen saving procedures (splenorrhaphy or partial splenectomy) should be tried. In case of total splenectomy, auto-transplantation, preferably in the omental pouch, may lead to return of immunity, at least partially, to prevent or reduce the chance of subsequent infection. Although total splenectomy with autograft is immunologically superior to total splenectomy-only procedure, these patients should also be protected by vaccination and daily antibiotic for certain period of time. The essential steps for prevention of overwhelming infection after total splenectomy are not only immunization and administration of daily antibiotic (up to 5 years of age or one year in older children), but include education and information about this dangerous complication. When non-operative management is successful, the duration of activity restriction (in weeks) is almost equal to the grade of splenic injury plus 2.
Trauma,Spleen,autograft,infection,Nonoperative management
https://ijms.sums.ac.ir/article_39757.html
https://ijms.sums.ac.ir/article_39757_698a6800f307d26947bd668d7a6a27f0.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Parenteral Albumin Therapy in Burn Patients: A Randomized Controlled Trial
95
100
EN
Ali Akbar
Mohammadi
0000-0002-5769-9508
mohamadiaa@sums.ac.ir
Mohammad Jalal
Hashemi-Nasab
Reza
Ershadi
ershadir@yahoo.com
Ahmad Reza
Tavakkolian
Nasir
Fakhar
Hamid Reza
Tolide-ie
Mohammad Kazem
Mohammadi
Background: Administration of albumin for burn patients and its effects on mortality and morbidity has been debated for along time. The aim of this study was to evaluate the effects of albumin administration on wound healing, length of hospital stay, weight change, and mortality of burn patients. Methods: Two matched groups of patients from Shiraz Burn Care Center were randomly selected. The patients in one group received parenteral albumin in addition to high protein diet and the other group received only high protein diet. The length of hospital stay, healing time, mortality, serum albumin, transferrin levels, and weight loss were compared. Results: A total of 141 patients were selected; 71 patients in control group and 70 patients in albumin group. There were no significant differences in mortality (P=0.97), length of hospital stay (P=0.45), and healing time (P=0.25) in two groups. The patients who survived had significantly higher serum transferrin level (128 mg/dL versus 102 mg/dL). Conclusion: Parenteral albumin administration did not have a significant effect on mortality, length of hospital stay, and healing time in burn patients.Trial Registration Number: IRCT138802141605N3
Albumin,Burn,transferrin,Wound healing
https://ijms.sums.ac.ir/article_39758.html
https://ijms.sums.ac.ir/article_39758_e538dda4d92bcfccbc4e4f1cdac32fc8.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Prevalence of Multiple Drug Resistant Clinical Isolates of Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae in Southeast Iran
101
108
EN
Shahla
Mansouri
Department of Microbiology,
Kerman University of Medical Sciences
smansouri@kmu.ac.ir
Samaneh
Abbasi
10.30476/ijms.2010.39762
Background: Multidrug resistance and production of extended spectrum β-lactamases (ESBLs) by enteric gram-negative rods in hospitals and community continue to be worsened. We aimed to characterize the multidrug resistance and determine the prevalence of ESBL production by clinical isolates of Enterobacteriaceae in southeast Iran. Methods: Gram-negative bacteria isolated from clinical samples of hospital inpatients and outpatients from three hospitals in southeast Iran were tested for susceptibility to 10 commonly used antimicrobials. For 500 isolates which showed resistance to ≥3 antibiotics from different classes, minimum inhibitory concentration, and prevalence of ESBL production were determined by agar dilution and double disc synergy method respectively. The isolated bacterial species were compared in respect of antibacterial resistance, ESBL production, patients' gender, hospital ward, and type of specimen. Results: The most frequent resistance was to trimethoprim/ sulfamethoxazole, amoxicillin, and tetracycline. Imipenem with 99.8% and ceftizoxime with 83% susceptibility were the most active agents. A total of 53.8% of isolates expressed ESBL production. Escherichia coli and Klebsiella pneumoniae were most common in outpatients, and inpatients samples respectively. Higher rate of resistance to most antibacterial agents and ESBL production was found in samples of inpatients. Conclusion: The present study showed high prevalence of ESBL-producing Enterobacteriaceae especially in the patients admitted to hospital. Infection control strategy with continuous resistance surveillance is essential to monitor in vitro susceptibility to antibacterial agents currently used in clinical practice. Determination of the type of involved ESBL enzymes is important for a better antimicrobial control and empirical therapy of critically ill patients in hospitals.
Antimicrobial resistance,Enterobacteriaceae,Outpatients,Inpatients
https://ijms.sums.ac.ir/article_39762.html
https://ijms.sums.ac.ir/article_39762_909e832fb8eebe57c956c440dec8b93b.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Isolation, Identification, and Profile of Antibiotic Resistance of Bacteria in Patients with Cancer
109
115
EN
Zahra
Eslami Nejad
eslamie_33333@yahoo.com
Elham
Ghafouri
Zahra
Farahmandi-Nia
Behjat
Kalantari
Fereshteh
Saffari
Background: Blood stream infection is one of the main causes of morbidity and mortality in patients with cancer. The purpose of this study was to evaluate the prevalence of aerobic and anaerobic-bacteremia in hospital inpatients with cancer and to determine the antibiotic resistance profile in isolated organisms in Kerman, southeast Iran. Methods: Total of 240 blood cultures from 136 patients were examined. The blood cultures performed in BACTEC media and were assessed for four weeks in aerobic and anaerobic conditions. Identification of isolates and antibiotic susceptibility test were performed by standard methods. Results: 24.6% of blood cultures were positive. The prevalence of polymicrobial bacteremia was 12%. Forty-three out of 65 isolated bacteria (66%) were gram positive and others (34%) were gram negative. Coagulase negative Staphylococci (21.5%), Propionibacterium spp (15.4%), Diphtheroid spp (12.3%), and Escherichia coli (12.2%) were the dominant isolated bacteria. All Staphylococci were methicillin resistant. The only isolated Pseudomonas putida and 37% of isolated Escherichia coli were multi-drug resistant. A number of Streptococci, Klebsiella, and Alcaligenes spp were also resistant in part to the antibiotics. Conclusion: Patients with cancer may be readily infected by many opportunistic pathogens including multi-drug resistant strains.
cancer,bacteremia,antibiotic resistance
https://ijms.sums.ac.ir/article_39766.html
https://ijms.sums.ac.ir/article_39766_9a4c8614a29dff46a15d15d71e6ece79.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Comparison of Two ELISA Methods for the Laboratory Diagnosis of Acute Leptospirosis
116
121
EN
Hamid Reza
Honarmand
eshraghs@tums.ac.ir
Gholamreza
Abdollahpour
Seyyed Saeed
Eshraghi
Background: Leptospirosis is the most common zoonosis widespread in tropical and temperate countries with low social-economic status. We aimed to compare an ELISA kit with an in-house ELISA assay to test the serum samples of the patients who were suspicious of leptospirosis according to their clinical symptoms. Methods: A total of 282 serum samples of patients suspicious of leptospirosis admitted to hospitals in Rasht city (north of Iran) were examined for sero-diagnosis of leptospirosis. Blood samples were obtained with mean time of 6.36 days after the onset of the symptoms. Antibodies were detected using a commercial qualitative and by an in-house semi quantitative IgM and IgG ELISA and the results were compared with microscopic agglutination test (MAT) as the gold standard. All specimens with titers ≥320 against a pathogenic serovar in MAT were considered positive for leptospirosis. Results: The results of MAT have demonstrated that 70 serum samples (24.8%) had a positive reaction with one of the leptospira serovar. The sensitivity, specificity, positive and negative predictive values were 87.1% , 91.0 %, 67.8%, and 95.5% for in-house ELISA assay, respectively, and 100%, 42.9%, 36.6%, and 100 % for commercial IgM ELISA assay, respectively. Conclusion: Our results showed that IgM ELISA assay is a reliable and sensitive method for the laboratory diagnosis of acute leptospirosis. In-house semi quantitative IgM ELISA was more specific and commercial IgM ELISA was more sensitive.
leptospirosis,zoonosis,ELISA
https://ijms.sums.ac.ir/article_39768.html
https://ijms.sums.ac.ir/article_39768_8fe97dccb9541cceadf713c048cafc72.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Effects of Hydroalcoholic Extract of Matricaria chamomilla on Serum Testosterone and Estradiol Levels, Spermatozoon Quality, and Tail Length in Rat
122
128
EN
Saied
Karbalay-Doust
0000-0003-1071-1730
karbalas@sums.ac.ir
Ali
Noorafshan
0000-0003-1082-011X
noora@sums.ac.ir
Farzaneh
Dehghani
0000-0003-2217-5672
dehghanf@sums.ac.ir
Mohamad Reza
Panjehshahin
Ahmad
Monabati
Background: Matricaria chamomilla (chamomile) is a herb used to treat various human illnesses. The present study was conducted to investigate the effects of chamomile extract on spermatozoon quality, serum levels of estradiol and testosterone, and sperm tail length in male adult rat. Methods: Male Sprague-Dawley rats received extract of chamomile (400 mg/kg once daily, orally) during an 8-week period, while the control animals received water. After this period, the animals were sacrificed and the blood samples were obtained. The serum levels of testosterone, estradiol, and the number, motility, and morphology of spermatozoon were assessed. The spermatozoon tail length was assessed by a rapid stereological method. Results: The body weight, and weight, and volume of the testis in the control and experimental rats did not change significantly. Serum testosterone level was decreased (~76%, P<0.005) and the serum estradiol level was increased (~16%, P<0.04) in the experimental animals. The spermatozoon count and motility were decreased in the experimental group but spermatozoon morphology did not show significant changes. The mid-piece and total tail length were reduced in the experimental group (~22%, P<0.001). Conclusion: Matricaria chamomilla extract can decrease spermatozoa count and motility, spermatozoon tail length, serum testosterone level and increase serum estradiol level in male adult rat.
Matricaria chamomilla,Sperm,estradiol,Testosterone,Stereology
https://ijms.sums.ac.ir/article_39769.html
https://ijms.sums.ac.ir/article_39769_7634fa6031d38300939026ba5f7126ef.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Apoptosis of Rat Adipose-Derived Stem Cells during Transdifferentiation to Schwann-Like Cell
129
136
EN
Zolikha
Golipoor
iraj.ragerdi@gmail.com
Iraj
Ragerdi Kashani
ragerdi@tums.ac.ir
Mohammad
Akbari
akbari.mo@iums.ac.ir
Reza
Mahmoudi
Mehdi
Abbasi
Saeid
Nekoonam
Background: Adipose-derived stem cells (ADSCs) are a population of pluripotent cells used for tissue engineering purposes. The main purpose of the present study was to transdifferentiate the ADSCs to Schwann-like cells and to determine the intensity of apoptosis in ADSCs during the transdifferentiation process. Methods: ADSCs were isolated from the inguinal adipose tissue of adult rats and the identity of the undifferentiated ADSCs was confirmed by the detection of specific cells surface markers. The ADSCs were transdifferentiated by sequential administration of beta mercaptoethanol, all-trans retinoic acid and a mixture of forskolin, beta fibroblast growth factor, platelet derived growth factor and hergulin. The immunocytochemical properties of transdifferentiated Schwann-like cells were examined at specified time point. RT-PCR was used to investigate the gene expression of the undifferentiated and transdifferentiated ADSCs. Cell apoptosis was assessed with annexin/propidium iodide staining and 3-(4, 5-Dimethylthiazol- 2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Results: Expression of Schwann cell marker S100 was determined by immunocytochemical staining. RT-PCR analyses revealed that the induced ADSCs exhibited Schwann cell-specific markers such as S-100, P75, and glial fibrillary acidic protein on the 14th day. MTT assay and flow cytometry studies showed that of the total ADSCs in the differentiation medium, 50% of the cells died by apoptosis, but the remaining cell population remained strongly attached to the substrate and continued to differentiate. Conclusion: ADSCs could differentiate to Schwann-like cells in terms of morphology and phenotype. An increased cell death rate was noted and the principle mode of cell death was apoptosis.
Adipose tissue,stem cells,apoptosis,Schwann cells
https://ijms.sums.ac.ir/article_39770.html
https://ijms.sums.ac.ir/article_39770_d7096caf74c4a7d6b67f2230bb37459f.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Incidence of Phenylketonuria in Southern Iran
137
139
EN
Asadollah
Habib
habibi1380@yahoo.com
Mohammad Hossein
Fallahzadeh
Hamid Reza
Kazeroni
Amir Hossein
Ganjkarimi
10.30476/ijms.2010.39771
Background: Phenylketonuria is a hereditary, autosomal recessive disorder caused by deficiency of phenylalanine hydroxylase or its cofactor tetrahydrobiopterin. The purpose of the present study was to evaluate the incidence of this disorder in southern Iran. Methods: All the neonates born between 22/Dec/2004 and 7/Sep/2007 were screened and their blood samples were tested by colorimetric and high performance liquid chromatography methods to obtain a diagnosis of phenylketonuria. Results: Of the screened newborns (87091 females and 88143 males) 15 female and 13 male neonates were diagnosed definitely as having phenylketonuria. Conclusion: The incidence of phenylketonuria in girls and boys was 1.7 in 10000 and 1.5 in 10000, respectively (mean: 1.6 in 10000) in southern Iran (Fars province).
Phenylalanine,Phenylketonuria,Phenylalanine hydroxylase,tetrahydrobiopterin
https://ijms.sums.ac.ir/article_39771.html
https://ijms.sums.ac.ir/article_39771_ea9e874f5f77178bc41af61ba2fb0ca2.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Association between Sleep Duration and Body Mass Index and Waist Circumference
140
144
EN
Jamshid
Najafian
0000-0002-1472-1218
jamshid_najafian@yahoo.com
Noushin
Mohammadifard
Zahra Dana
Siadat
Gholamhosein
Sadri
Majid
Ramazani
Fatemeh
Nouri
Insufficient sleep may lead to adverse cardio-metabolic effects by influencing body weight, blood pressure, and glucose tolerance. We aimed to assess the relation between sleep duration and indices of obesity including body mass index (BMI) and waist circumference in a sample population in central Iran. We selected a sub-sample of 1770 individuals from Isfahan Healthy Heart Program. The data regarding the sleep duration was collected by using a validated questionnaire. The relation of sleep duration with BMI and waist circumference was examined by using categorical logistic regression with adjustment for sex, BMI, and daily calorie intake. Sleep duration time less than 5 hours/day compared with 7-8 hours/day increased the odds ratio for abdominal obesity in people aged under 60 years [OR=2.49 (95%CI 1.40-4.43)]. In individuals aged under 60 years, this relation was significant for both men, [OR=2.64 (95%CI 1.16-6.02]) and women [OR=2.38 (95% CI 1.05-5.39)]. In addition, in women, sleep time > 9 hours was negatively related to waist circumference. Sleep duration time less than 5 hours per day increased odds ratio of overweight only in women [OR=1.75 (95% CI 1.07-2.85)]. Sleep duration time under 5 hours in people aged less than 60 years was positively associated with waist circumference. In women, sleep duration time over 9 hours was negatively associated with waist circumference. Only in women, sleep time under 5 hours /night increased BMI. Short sleep duration was associated with abdominal obesity and this was independent of its relation to BMI.
Sleep,Obesity,gender differences
https://ijms.sums.ac.ir/article_39759.html
https://ijms.sums.ac.ir/article_39759_12710c7f8ecff6a08e41bbc600ec1d19.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Thrombolysis in Stroke Patients; Problems and Limitations
145
148
EN
Kavian
Ghandehari
kavianghandehari@yahoo.com
Mohsen
Foroughipour
Ali
Pourzahed
Marzieh
Taheri
m_taheri2008@yahoo.com
Maryam
Abbasi
Shirin
Gorjestani
Amir
Moghaddam Ahmadi
Mohammad Ali
Nahayati
Thrombolysis for stroke is being used in some developing countries. This study was designed to evaluate the problems of thrombolysis therapy in Iran. During January-July 2008, all patients with ischemic stroke admitted to Ghaem Hospital, Mashhad, northeast Iran, were enrolled in a prospective observational study. Ghaem Hospital is a tertiary care hospital that includes infrastructure for thrombolysis with tissue plasminogen activator (tPA). The stroke onset to hospital entrance time, hospital entrance to completed investigation time, contraindications of thrombolysis, and the capability of the patients to afford the treatment costs by their own were recorded. Of the 625 patients with ischemic stroke, 50 (8%, 30 men, 20 women) arrived at hospital within a 3-hour time window. About 44% of these early arrived stroke patients remained within the 3-hour time window to complete computed tomography and laboratory tests. About 30% of these patients were capable to pay tPA cost by themselves. Contraindications of thrombolysis by tPA were found in 58% of these early arrived stroke patients. Seven patients (five men, two women) were eligible for intravenous thrombolysis. The major hurdles in implementing the treatment are the high cost of the drug and the lack of priority for triage and investigation of hyperacute stroke patients.
Thrombolysis,tissue plasminogen activator,Iran
https://ijms.sums.ac.ir/article_39763.html
https://ijms.sums.ac.ir/article_39763_7d80b622606a9c2a843838900f6d06c2.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Bilateral Pulmonary Thromboembolism: An Unusual Presentation of Infection with Influenza A (H1N1) Virus
149
153
EN
Parviz
Saleh
Hamid
Noshad
hamidnoshad1@yahoo.com
Swine flue is a highly contagious acute respiratory disease caused by a subtype of influenza A virus. Herein we present three patients with H1N1 infection complicated with pulmonary thromboembolism. The patients had chest pain and unexplained dyspnea. Imaging studies showed bilateral hilar predominance. Computed tomographic angiography confirmed bilateral thromboembolism (an unusual presentation of H1N1 infection). We did not find any predisposing factor including endothelial damage, stasis, or hypercoagulable state in these patients. They did not receive any medication. After anticoagulation and treatment with oseltamivir, all the patients were discharged in good condition. To the best of our knowledge bilateral pulmonary thromboembolism has not been reported in English language literature in patients with swine flu infection. Appropriate diagnosis and treatment will be life saving in this condition.
H1N1,Influenza A,thromboembolism,Angiography
https://ijms.sums.ac.ir/article_39760.html
https://ijms.sums.ac.ir/article_39760_0c41906925fa75316e196bafecc1f03b.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Large Sphenoethmoidal Encephalocele Associated with Agenesis of Corpus Callosum and Cleft Palate
154
156
EN
Basir
Hashemi
kazemei@sums.ac.ir
Tayebe
Kazemi
Akbar
Bayat
Basal encephalocele is a rare craniofacial anomaly. In the present paper we report a 10-year-old boy presented with cleft palate, congenital nystagmus, and hypertelorism. During preoperative evaluation for cleft palate repair, a pulsatile mass was detected in the pharynx. Magnetic resonance imaging showed sphenoethmoidal type of basal encephalocele and agenesis of corpus callosum. Neurosurgical consultation was performed for further evaluation and management.
Encephalocele,Cleft Palate,nystagmus,corpus callosum
https://ijms.sums.ac.ir/article_39764.html
https://ijms.sums.ac.ir/article_39764_7f316d2d4ec73efb68b6f31bcf8ec519.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Splenogonadal Fusion Operated as a Malignant Tumor
157
159
EN
Mohammad Reza
Farzaneh
Mohammad Zaki
Abbasi
Batool
Amini
Splenogonadal fusion is a rare congenital malformation whereby the splenic tissue is found attached or surrounded by the testis, and presents in both continuous and discontinuous forms. Splenogonadal fusion may be misinterpreted as a primary malignant testicular or an adenomatoid tumor. Knowledge about the existence of such an entity is essential in order to preserve the testis during surgical operation. We describe a case of splenogonadal fusion in a young man with bilateral normal oriented scrotal testis.
Neoplasms,Spleen,tumor,Testis
https://ijms.sums.ac.ir/article_39767.html
https://ijms.sums.ac.ir/article_39767_670941395221b4e7d07b3b0d87e1aa2d.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
The Role of Appendix in the Management of Biliary Atresia Associated with Bowel Atresia
160
161
EN
Seyed Mohammad Vahid
Hosseini
psrg.sums@yahoo.com
Mohammad
Zarenezhad
Soheil
Benrazavi
Biliary atresia is characterized by the progressive obliteration of extra- and intrahepatic biliary duct system leading to the obstruction of bile flow in infancy. The cause(s) of biliary atresia remain unclear and many surgical options for bypassing the atretic segment have been described.1-3 Biliary atresia may be associated with small bowel atresia. The surgical interventions for biliary drainage in this co-morbidity are problematic because of associated inadequate length of bowel for reconstruction while the combined effects of short bowel syndrome and delayed return of adequate motility and absorptive capacity cause the ascending cholangitis.4,5A 2-day-old boy was referred to us because of jaundice, bilious vomiting, and abdominal distension. He was diagnosed as having proximal jejunal atresia. During an operative exploration, the intact remaining of the terminal ileum (10 cm) was anastomosed with proximal pouch (15 cm) end to back fashion but the gall bladder was ignored. He had a good postoperative course and tolerated feeding on the 10 th postoperative day. However, his stool was clay colored and the jaundice persisted. We evaluated him for any surgical causes of neonatal jaundice which showed the absence of gall bladder in abdominal sonography and there was no evidence of excretion of bile into the bowel in HIDA scan. He underwent the second laparotomy and the appendico-duodenostomy was performed for biliary atresia because of a short bowel [figure 1]. The patient developed greenish stool on the 4th postoperative day and discharged with medication.Jaundice in small bowel atresia is not unusual because 20% of cases with small bowel atresia are associated with jaundice.6 The diagnosis of small bowel atresia is definite in all cases at the first glance, but accompanying biliary atresia is not usually detected because of ignoring the gallbladder in all cases during the first operation or having a preoperative ultrasonography without details of the gallbladder. Therefore, we recommend that the gallbladder be examined during the first operation for small bowel atresia. Many techniques for utilizing the appendix as a biliary conduit have been recommended with different results. Appendico-duodenostomy can prevent the reflux cholangitis and save the entire small bowel.7 Therefore, appendix as an anti-reflux conduit, is useful for reconstruction of biliary tree and prevention of ascending cholangitis.
https://ijms.sums.ac.ir/article_39761.html
https://ijms.sums.ac.ir/article_39761_0b1250bf9f30d3f0f00061c6e5aaf436.pdf
Shiraz University of Medical Sciences
Iranian Journal of Medical Sciences
0253-0716
1735-3688
35
2
2010
06
01
Effect of Stress on Coronary Risk Factors
162
163
EN
Thambiraj Antony
Thangadurai
antonythangadurai@yahoo.co.in
Chelladurai Savariraj
Sagayam
Gnanarajamanickam Victor
Rajamanickam
Govinda Prasad
Dubey
In India, a survey indicates the prevalence of 30 times increase in hypertension among urban dwellers, compared with 10 times in rural inhabitants.1 Urbanization together with a change in life style, diet, and job stress, has been attributed in causing hypertension.Stress can cause hypertension by elevating the blood pressure (BP) and by stimulating the nervous system leading to the production of large amounts of vasoconstrictor hormones. High BP due to stress includes white coat hypertension, job strain, race, social environment, and emotional distress. BP is multiplied when more than one risk factor are involved. Emotional stress-activated sympathetic nervous system increases circulating angiotensin II, aldosterone, and vasopressin, which increase systemic vascular resistance. Prolonged elevation of angiotensin II and catecholamines can lead to cardiac and vascular hypertrophy, both of which can contribute to a sustained increased BP.2 Karasek Demand-Control model describes the relationship between perceived job stress and coronary heart disease (CHD).3 Job strain, high job demands, and low decision attitude increase the risk of CHD whereas Tien has demonstrated the other way.4The present study consists of 72 workers of both genders working in a bank. The study measured different metabolic risk factors and biochemical parameters. The job characteristics including job strain, mental stress, medical history, and behavioral characteristics including smoking and alcohol consumption habits were assessed by using a questionnaire. Pearson correlation coefficient and linear regression model between the levels of BP, serum glucose, cholesterol and triglyceride levels and the job stress were carried out using SPSS software version 12.0.Among the demographic variables, age was negatively correlated with diastolic BP (r=217), but no significant correlation was found. Body mass index (BMI) was significantly correlated with diastolic BP (r=0.424), serum triglyceride (r=0.342), and blood glucose (r=0.234). Systolic BP was found markedly correlated with job stress (r=0.192). Our results showed an increase in the systolic BP for middle aged adults with high job stress, whereas others did not show significance correlation with job stress. Therefore, it is concluded that job stress can alter the metabolic risk factors. Further, the relationship between BMI and biological risk factors including serum triglyceride (r=0.391) remains significant. The middle aged adults displayed positive relationship between serum glucose and triglyceride (r=0.347). It directs that different life styles such as eating habits, smoking frequencies, and consumption of alcohol, have distinct effects on biological factors. The statistical results revealed that there was a relationship between the working condition and metabolic risk factors. The scatter plot suggests that there was a significant direct correlation between the systolic BP (r=0.255) and higher job stress. BMI was characteristically related to the working condition among male workers, but not females. Lack of relationship between glucose and job stress and inverse relationship of total cholesterol and triglycerides, direct an association between work duration and the hypertension that is observed to be a risk factor of cardiovascular disease.Metabolic syndrome, a concurrence of hypertension, dyslipidemia, hyperglycemia, and central obesity are strong risk factors in cardiovascular diseases.5 However, stress and work site environment influence cardiovascular complaints. Work stress is typically associated with increased BP and job characteristics. The present study does not concur the above risk factors for CHD for bank employees. Instead, it gives emphasis to stress-induced response on BP during working hours. It projects that high job strain is associated with a higher systolic BP. In the study of Kang and colleagues,6 job stress has shown to be involved in elevated serum triglycerides and cholesterol levels, whereas in the other study, acute psychological stress reduced plasma triglycerides and cholesterol.7Earlier studies have presumed that the stress associated with aversive condition, decreases the levels of circulating triglycerides,and increases lipoprotein lipase.8 However, the hypertension caused by job stress may be attributed either to physical stress or emotional stress, while the group of bank employees may not be expected to have physical stress and invariably exposed to emotional stress.Hypertension is the function of metabolism and hormonal imbalance. The present study found no rise in plasma cholesterol and triglyceride levels of those having hypertension. During stress, hypertension is increased either by hormone release,9 or burning out of the carbohydrates. Generally, chronic stress influences the cardiovascular complaints. Bank employees may not have such stress and so the hormone imbalance must have triggered the hypertension. It is accepted that stress elevates blood glucose levels and worsen glycemic control. However, research on psychological stress is limited, so Wing reported only a temporal shift in the glucose level.10It is concluded that CHD risk factors such as plasma cholesterol and triglycerides levels are posing less risk, whereas hypertension such as systolic BP increases during high job stress. Hence, the incidence of CHD is more possible due to job stress associated hypertension.
https://ijms.sums.ac.ir/article_39765.html
https://ijms.sums.ac.ir/article_39765_129325105b659f031941095af76f1eeb.pdf