Soil heavy metals are associated with the distribution of multiple sclerosis in Isfahan, Iran.

BACKGROUND: Few epidemiological studies have explored the effects of soil pollution on multiple sclerosis (MS) risk in Asia. METHOD: Based on catchment areas, Isfahan province is divided into five regions (Central, North, East, West, and South), and Soil sampling performed in catchment area with the highest range of MS prevalence and incidence. Samples were analyzed for cobalt (Co), lead (Pb), cadmium (Cd), copper (Cu), zinc (Zn), and absorbable forms of Pb, Cd, and Co. Linear regression is used to examine the association of soil heavy metals with prevalence of MS in central part of Isfahan province. RESULT: Multiple sclerosis prevalence ranged from 5.62 to 156.65 in different townships. Based on regression analysis, in case of considering fixed amounts for the rest of elements, a one (SD) increase of absorbable Pb and absorbable Cd are associated with 0.385 (SD) (P < 0.0001) increase and 0.209 (SD) (P < 0.007) decrease in MS prevalence, respectively. CONCLUSION: This study documented a significant association between exposure to absorbable Pb and Cd in soil with prevalence of MS in Isfahan. Further work is warranted to confirm this association and if validated, to understand the mechanisms behind the association.

Prosthetic incisional hernioplasty: clinical experience with 354 cases.

BACKGROUND: The use of prosthetic materials has become the standard of care in the management of incisional hernias because of its association with a low rate of recurrence. In this paper, the results of the treatment of incisional hernias is reported. METHODS: Over a 15-year period, 354 open abdominal wall incisional hernia repairs were performed using the Rives-Stoppa, onlay and inlay techniques. The prosthetic materials used were polypropylene and Mersilene mesh. Using a questionnaire, the individual characteristics, type of operation (technique), type of prosthesis, complications and surgical outcome were recorded and analysed by SPSS software. RESULTS: A total of 354 patients underwent prosthetic incisional hernioplasty, comprising 265 women and 89 men, with a mean age of 52.1 years, using three techniques that included Rives-Stoppa (312), onlay (33) and underlay (9). The majority of complications included seroma (10), infection (8), intestinal fistula (2), mesh removal (2) and respiratory complication (4). Eighty percent of the patients used abdominal belts after the surgical procedure. Recurrent hernias were observed in four patients with a mean of 98 months follow up. All patients received pre-operative intravenous antibiotics and were discharged with oral antibiotics. CONCLUSION: In this series, the prosthetic incisional hernioplasty approaches, especially the Rives-Stoppa method, yielded excellent long-term results, with minimal morbidity in patients and large primary or recurrent incisional repair.