مجله دانشکده پزشکی اصفهان
پیاپی 736 (هفته چهارم آبان 1402)

Exposure of operating room personnel to some chemicals, including formaldehyde (FA) and inhalational anesthetics can cause liver and kidney damage. This study was performed to assess liver and kidney functions and to determine the FA concentration in the breathing zone of operating room personnel.

In this cross-sectional study that was conducted in Yazd hospitals in 2022, 150 operating room personnel exposed to formaldehyde, and 150 nurses from other departments of the same hospitals (control group) without any history of exposure to formaldehyde, were selected. A questionnaire including demographic information and history of systemic diseases was completed by the participants. 5 cc of fasting blood samples were collected to evaluate liver and kidney functions. FA concentration was determined by the NIOSH 3500 method.

The mean concentration of FA in the breathing zone of operating room personnel was 3.34 ± 2.87 ppm, which was significantly higher than the Occupational Exposure Limit (OEL) of 0.1 ppm proposed by Iran's Ministry of Health and Medical Education. The levels of alkaline phosphatase (ALP) and aspartate aminotransferase (AST) as biomarkers of liver damage, and serum creatinine as a biomarker of kidney damage were significantly higher, in the exposed group than in the non-exposed group.

The findings of the present study showed a statistically significant association between high concentration of formaldehyde and high levels of liver enzymes and serum creatinine in the operating room personnel in Yazd hospitals.

Hypoxic encephalopathy in adults is associated with different causes including Cardiorespiratory arrest, shock, and some poisonings such as carbon monoxide poisoning.

In this case series study, all the poisoned patients who had hypoxic encephalopathy based on radiological findings and were admitted to the poisoning department of Taleghani and Imam Khomeini hospitals in Urmia between 2016 and 2016 were included. Demographic characteristics, type of poison, type of poisoning, imaging findings, mortality, and length of hospitalization were extracted from the available files.

A total of 14 patients, all of whom were men, with an average age of 41.21 years, were examined. 64.3% of patients had a history of addiction. 85.7% of poisoning cases were unintentional. The most common intoxicant was methadone (42.6%) and the most common cause of encephalopathy was cardiorespiratory arrest (50%). The most common CT scan finding was diffuse edema and loss of white and gray matter differentiation, and the most common laboratory finding was leukocytosis. The average length of hospitalization was 34.4 days. The mortality rate was 85.7%.

Drug-consuming patients are at risk of overdose and possible occurrence of hypoxic encephalopathy, increasing the length of stay in hospitals, and death.

Adrenoleukodystrophy is an X-linked neurodegenerative disease that affects the central nervous system, especially the white matter and myelin. The most common early symptoms of the disease are cognitive and perceptual disorders, which gradually and over time other symptoms of the disease, including changes in behavior in the form of social withdrawal and depression, gait disorders, and cerebellar symptoms appear. Attention Deficit Hyperactivity Disorder (ADHD) is a common disease that affects both children and adults and is characterized by inappropriate age-related symptoms in the dimensions of inattention or hyperactivity.

Case Report: 

Although behavioral disorders are seen frequently in the course of the adrenoleukodustrophy, it is not common to observe these disorders as presenting sign of the disease without other neurological manifestations. Here, we present a five years old boy who suffered from attention deficit -hyper activity disorder with failure in treatment with risperidone and gradually worsening the symptoms .After neurological investigations, final diagnosis of adrenoleukodystrophy was confirmed for the patient.

In this article, we reported a 5-year-old child with mood swings and hyperactivity diagnosed with adrenoleukodystrophy. One of the rare clinical manifestations of this disease is behavioral changes, which in the case of our patient initially had only behavioral changes.