Background: Somatic signs Perceived Stress and Self-Efficacy are differ in smoker and non-smoker students. The purpose of present study was investigating the somatic symptoms perceived stress and self-efficacy in smoker and non-smoker students.Methods: 200 volunteer students 100 smokers and 100 non-smokers were selected and completed the somatic signs checklist perceived stress and self-efficacy scales.Results: The results indicated that in smoker student’s highest rate of somatic symptoms were chronic coughing (20%) respiratory diseases (17%) pulmonary problems (17%) acute HEADACHE (9%) dizziness and nausea (9%) fatigue and weakness (8%) and cardiovascular diseases (6%). Statistical analysis between smoker and non-smoker students showed that mean of negative perceived stress in smoker was significantly higher than non-smoker students 18.65±4.33 and 15.02±3.07 respectively (p=0.001). The mean of positive perceived stress in non-smoker students (15.86±2.92) was significantly higher than smoker students (13.08±2.37) (p=0.001). The results confirmed that the self-efficacy in non-smoker students was significantly higher than smoker students (33.1±8.37 vs. 26.40±8.58 and p=0.001).Conclusion: Our findings support the existence of somatic symptoms in smoker students and positive perceived stress and self-efficacy in non-smoker students. Training strategies of better coping with stress in students and referring smokers to the students counseling center to enhancement of self-efficacy is suggested.

Precocious puberty is the appearance of secondary sexual characteristics before 8 years old in girls and 9 years old in boys. Precocious puberty is divided into 3 groups of central, peripheral and normal variants. Central precocious puberty is accompanied by activation of hypothalamic-pituitary-gonadal axis which causes increase in secretion of Gonadotropin Releasing Hormone(GnRH) and in turn increase in secretion of gonadotropins (LH and FSH) from pituitary and consequently increase in secretion of sexual steroids (estrogen or testosterone) from gonads. This results in premature closure of growth plates and shorter final height. GnRH agonists via suppression of hypothalamic-pituitary-gonadal axis, causes decrease sex steroid production, prevention of bone age advancement and ultimately result in increasing final height in patients. Central Precocious puberty is the most common type of precocious puberty, which has a higher prevalence in girls. Use of GnRH agonists is the best treatment for central precocious puberty. This article reviews important factors affecting selection of patients with central precocious puberty, to be treated by GnRH agonists. Purposes of treatment with GnRH agonist:-The main objective of treating patients with central precocious puberty is to prevent premature closure of growth plates and providing enough time for height growth to ensure normal final height.-The other purpose of treatment of these patients is to lower their psycho-social stress, emanating from precocious beginning of pubertal signs in these children and their families.-Stoppage of menarche in patients with mental retardation or cerebral paralysis that are not able to manage their menarche. The level of increase in final height after treatment with GnRH agonists on patients with precocious puberty varies. Factors affecting final height of patients with central precocious puberty after treatment with GnRH agonists:-Pubertal beginning age: the sooner commencement of pubertal age happens, the shorter final height will be.-Advancement of bone age: this factor, at the commencement phase of treatment and its termination, is accompanied by shorter final height. This indicates that if treatment is delayed to after a specific bone age (advanced), then reviving the entire potential of final height is not feasible. Kauli and his colleagues indicated that if treatment starts prior to advancement of bone age to 12 years old, it would be more useful.-Height Standard Deviation Score (SDS): Higher SDS of patients height at the beginning or end of treatment, results in higher final height.-Target height: if target age is taller, then final height increases. Main factors for selecting patients with central precocious puberty, for their treatment with GnRH agonists: Age of patients at the beginning of pubertal signs: in patients with central precocious puberty, the lower is their age, the faster progresses their pubertal signs and bone age. This causes premature closure of growth plates and shorter final height. Rate of sexual maturation: patients with central precocious puberty, in terms of advancement of their pubertal signs, are divided into two groups of rapidly progressive and slowly progressive. In the latter group, pubertal signs and bone age progresses rapidly and this leads to shorter final height. Predicted adult height: the most common way of calculating predicted adult height is bayley-pinneau. In this method, final height is calculated on the basis of percentage of current height, bone age and relation between bone age and calendar age. Patients with precocious puberty, with lower predicted adult height, will have shorter final height.-Other factors that are needed to be taken into account in treatment of central precocious puberty are: family background of precocious puberty,small for gestational age and adapted child. Familial forms of precocious puberty are more advanced than sporadic cases. Small for gestational age children, early puberty (not precocious puberty) are turned to rapid progress in bone age and shorter final height. In summary, groups of patients with central precocious puberty benefit from treatment with GnRH agonists are: 1-Girls with central precocious puberty under the age of 6 years old and all boys with central precocious puberty under 9 years old,2-Girl patients with rapidly progressive central precocious puberty, the one tanner stage of whom progresses in less than 3-6 month,their velocity of height growth is more than 6 centimeters in a year,and their bon age is 1. 5-2 years earlier than their calendar age,3-Girls with central precocious puberty, predicted adult height of whom is more than 150 cm, and boys with central precocious puberty, with their predicted adult height more than 160 cm, do not require treatment and will achieve their final height. GnRH agonists available for treatment of central Precocious puberty: Leuprolide: dose of 3. 75 mg for monthly IM injection and dose of 11. 25 mg for 3month IM injection,Triptorelin: dose of 3. 75 mg for monthly IM injection and dose of 11. 25 mg for 3month IM injection. Also doses of 22. 5 mg for 6 months IM injection,Histrelin: dose of 50 mg, subcutaneous implant for one year. Common side effects of treatment with GnRH agonists: hot flashes, HEADACHE, pain at the place of injection, local skin reaction at the place of injection, an in an uncommon manner sterile abscess at the place of injection. After termination of treatment, hypothalamic-pituitary-gonadal axis, will revive again and pubertal signs appear. Conclusion: Nowadays, GnRH agonists are widely used for treatment of central precarious puberty. This happens while age of puberty has decreased in normal population. The lower, age of patients with Precocious puberty is, rate of progress in pubertal signs is faster, final predicted adult height is lower,these patients benefit more from treatment by GnRH agonists.

Introduction: Allergic rhinitis is one of the most important diseases that occurs commonly in east IRAN specially northeast, Khorasan. Approximately 10-15% of general population suffers from it. One of the best methods of treatment of allergic rhinitis, that is the most usual, is the usage of classic antihistaminic drugs (such as Chlorpheniramine), but their side effects, specially somnolence and malaise, made a few patients to discontinue such treatment. More than a decade has showed that the Non Sedating Anti Histaminic Drugs (Terfenadin, Astemizole and Loratadine) are free from these side effects and do not show the CNS and anticholinergic disorders. The evaluation of their efficacy in the epidemiology of IRAN, beside the comparison of generic products with the registrated ones, is the main goal of this research.Material and Method: In this clinical study, the efficacy and adverse reactions of the Loratadine and its registrated product called Claritin are compared with Chlorpheniramine on 90 patients. It has been performed in northeast IRAN and the study is a kind of double blind, prospective studies. 30 patients have received Chlorpheniramine, as the same for Loratadine and Claritin. Then the results are compared with each other by Chi- square test.Results: According to results and the P. value for each controlled sign and symptoms, it seems that all the three drugs act effectively in this setting. On the other hand, there is a suitable growth in their efficacy from Chlorpheniramine toward Loratadine and then Claritin. Also for the side effects, there is a meaningful difference in somenolence, HEADACHE, giddiness and xerostomia between Chlorpheniramine with the others and also a decline in these side effects from Loratadine toward Claritin.Conclusion: The results suggest that in the geographic condition of IRAN, Loratadine and specially Claritin can be use as the powerful and effective nonsedating antihistamines that do not cross the blood brain barrier to show adverse disorders and will be a successful treatment of Allergic rhinitis in the first line, specially in patients who are sensitive to other antihistaminic drugs. Claritin due to acceptable clinical efficacy and lower side effects is preferred to Loratadine and makes the drug managers to pay more attention to quality improvement of the generic products.

Introduction: Increases in the world population and changes in the pattern of urban life together with the countless sources of air pollutants in semi-closed spaces have changed the air space of our cities into a hostile environment. Therefore, the problem of air pollution is not only limited to the outdoor environment but also became a real problem in indoor spaces. In modern cities, people spend 70-90 percent of their time in indoor spaces and their activities are limited more to these environments. Carbon monoxide is one of the most dangerous gaseous pollutants in the buildings with both residential and industrial operations that are frequently reported to cause diseases and death. Carbon Monoxide (CO) is a colorless, odorless, and tasteless flammable gas that is slightly positively buoyant compare to air. Carbon monoxide is produced from the partial oxidation or burning of fossil fuel (coals, oil, and natural gas) or any other carbon-containing compounds. CO can build up indoor spaces and poison people and whoever (animals and plants) breathe it. Poisoning due to Carbon monoxide is a common type of fatal air poisoning reported around the world. The most common symptoms of CO poisoning are HEADACHE, dizziness, weakness, upset stomach, vomiting, chest pain, and confusion. Many researchers such as Sykes and Walker (2016) and Levy (2015) have investigated the health effects and the risk of CO poisoning on resident safety and peace. Various concentration of CO is found in fumes produced by burning fuel in workshop buildings and Industrial Units. It is ranged from 2 to 5 percent (20, 000-50, 000 ppm) and can cause long-term health problems to workers who breathe it. Various health organizations have established the Carbon Monoxide (CO) concentration limits. ASHRAE sets outdoor maximum levels at 35 ppm (1 hour averaging) and 9 ppm (8 hour averaging), while the World Health Organization limits CO concentrations based on exposure time ranging from 90 ppm (15-minute exposure) to 10 ppm (8-hour exposure). The ASHRAE indoor's maximum concentration limits for CO in industrial units is 50 ppm (8 hour averaging), which is usually hard to meet in place works and workshops. Harmful health effects of carbon monoxide make it essential to be able to predict the behavior of flow in indoor spaces for the successful implementation of any mitigation measures. Natural or forced ventilation is the simplest way to reach acceptable indoor air quality standards. Numerical and experimental models are common tools to predict the behavior of airflow in indoor and outdoor spaces. Experimental works also by providing a benchmark for the calibration of the numerical works and by developing the empirical equations for the prediction of flow patterns are commonly used to define airflow in indoor spaces. Modeling of airflow through the simulations of flow in the water tank has rarely been investigated. Chen et al, (2010) used a water tank and LIF technique to simulate contaminant distribution inside an airliner cabin using a one-tenth scale water model. The same approach has been followed in the current study. A small scale model of a workshop has made to simulated airflow distribution and transport. To correctly represent the flow, a small-scale model should be designed based on similarity analysis, in which the relevant dimensionless flow parameters are identical between small-and full-scale. The similarity of the forces is reached by the equality of Froude or Grashof and Prandtl numbers. Materials and Methods: For the flow of carbon monoxide, regarding the density difference between CO plume and air the forces of inertia and buoyancy (density difference) are dominated. Due to the high turbulence of the flow, the viscous force is negligible compared to the two aforementioned forces. Therefore, the Froude number that consists of the important properties of the flow can be considered to set the similarities. On the other hand, regarding low velocities compare to the speed of sound (Mach number <1) the compressibility of flow can be ignored. So, the density difference and inertial forces are the only important forces and flow can be assumed incompressible carefully. In this study, a simple regime of CO plume from a point source in a workshop building has been investigated. The building is a 3 mm perspex box that is 30 cm long, 30 cm wide and 35 cm tall with the sloping roof at both sides. The flow of contamination is a CO plume on the floor with a diameter of 1 cm. The discharge speed is 10 cm/s and the CO concentration is 20, 000 ppm, so the Froude number is 1. 44 and the Reynolds number is equal to 1124. A roof window, 1 cm wide and 10 cm long, is considered for the outflow. The experimental works are performed at the Environmental Fluid Mechanic Laboratory of Babol Noshirvani University of Technology, Iran, using the Three-Dimensional Laser-Induced Fluorescence (3DLIF) system that especially developed for this purpose. The scaled experimental test facility placed upside-down fully submerged in the water tank. Conducting the experiment in a water tank besides index-matching is simpler to quantify flow mixing and dilution using the illumination of fluorescent. Discussion of Results: In this study, the behavior of a plume of carbon monoxide in the indoor space of a stationary environment was investigated where no wind or forced ventilation implemented. CO is less dense than the ambient air and the flow moves upward due to its initial buoyancy. The flow reaches the steady-state condition after some seconds from the beginning. The concentration of contamination decreases due to flow entrainment and mixing while plume moves upward. The dimensions of buildings and outflow roof window determine the time requires to reach steady-state and it was 50 seconds for this experiment. So the experiment was recorded after this time when it became time-independent. This time would be exactly equal for the same size building in either water or air. However, the time is proportional to T_P/T_M =√ (L_P/L_M ) between model and prototype. For the flow speed also the same relation i. e. V_P/V_M =√ (L_P/(L_M )), is established. The mixing and dilution of the contamination are proportional to flow speed and its initial buoyancy. Due to the dominant forces, the flow goes upward to eventually reaching to the ceiling, then moves outward from the roof widow up to reach the steady-state condition. In the uniform steady flow of CO smoke, a stratification forms in the building in which the concentration gradually decreases from the floor (20, 000 ppm) up to the ceiling (2, 600). As a result of this study, self-similarity was observed for the profile of concentration and plotted at different locations from the source ( ). The 2D configuration of flow, changes in flow width and centerline concentration are also plotted. Conclusions: In this study, utilizing the LIF system, the spatial and temporal changes of CO concentration from a plume of contamination in a workshop have been investigated. Concentration variation along the centerline is plotted along with the changes in flow width and pollutant distribution in the building. For the aforementioned dimension with a point source at the floor and a roof window at the ceiling, it observed that the flow reaches the steady-state condition after about 50 seconds in which as stable stratification forms in the building. The CO concentration gradually increases from zero to maximum from the floor up to the ceiling. The pattern of changes depends to flow initial fluxes and the roof window's dimensions. The effect of walls on entrainment restriction and the ceiling on flow re-entrainment were observed and plotted as the self-similar profiles. The concentration of CO found in the range of danger at the height of human respiration in this building. It shows that natural ventilation can not decrease the high concentration of CO in this plume. Forced or mechanical ventilation is required.

Background and aims: Presently, human kind is challenging with a highly contagious disease, COVID-19, caused by a newly emerged virus, SARS-COV2. Health care providers are at the front line of fighting, as well as, at the risk of getting infected. Many attempts have been made to combat the disease are mostly focused on hospital settings rather than outpatient settings so far. Therefore, addressing the clinics and medical offices with numerous health care workers seems necessary. Methods: Using keywords COVID-19 OR SARS-COV-2 OR Corona virus, AND Infection control OR Prevention AND ( Outpatient settings) OR clinics OR (medical offices) AND (health care workers) OR (health care personnel) in databases and pertinent sites: PubMed, Cochrane Library, Scopus, Up-to-date, Clinical Key, Google Scholar, guidelines, and health organization like CDC, W. H. O., high impact journals, and publications of Iran ministry of health related to outpatient settings, we searched the medical literature for all published full text articles pertinent to medical practice in clinics and medical offices and COVID-19 disease. We collected all pertinent data, and then organized them in a step by step guide for health care workers. Results: Based on our findings, the majority of patients (80%) with COVID-19 have mild disease and no need to primarily be admitted to hospitals. Since these patients are the source of infection, referrals to all clinics and hospitals have the risk of transmission of the infection to medical staff as well as, other non-COVID patients. They could be quarantined at home, evaluated by physicians via telemedicine, receive appropriate medical advice, and followed up regularly. Tele visit: Tele visit via telephone or video call eliminates unnecessary public or private transportation and the risk of transmission, as well as, face to face visits and exposing health care workers and other patients to the virus. Regarding limited health care resources, face to face unnecessary visits impose dual pressure upon an already overloaded health care system. Emergency departments and hospitals should be dedicated to the remaining 20% of COVID patients with moderate to severe disease. Signs and Symptoms: Signs and symptoms of myriads of COVID-19 patients have been assessed. 27 signs and symptoms have been found common to patients. 4 out of 27 signs and symptoms most consistent with the disease are: fever, HEADACHE, fatigue, and myalgia/arthralgia. Moreover, one of the relatively characteristic symptoms of COVID-19 disease is, sudden and recently-onset loss of smell and taste in the context of other signs and symptoms. It should be differentiated from chronic and already present loss of smell, associated with chronic diseases like nasal polyposis, chronic sinusitis and neurologic problems. Other alarming Signs and symptoms that need to be sought are: hemodynamic instability (hypotension and reduced urine output), decreased level of consciousness, and chest pain. Patients with these conditions need to be admitted to hospitals. Approaching patients with dyspnea remotely, Physicians should consider differential diagnoses like exacerbation of asthma or chronic obstructive pulmonary disease (COPD), severe pneumonia, heart failure, pulmonary embolism, pericarditis, and anxiety. Oxygen saturation evaluation: Patients could be instructed to monitor their oxygen saturation by home pulse oximeters twice a day and report it to physicians. If oxygen saturation is 95% or more with room air, and not having other risk factors, they could remain quarantined at home. Patients with oxygen saturation of 94% or less should be visited face to face in medical centers. Elevator etiquette: If you have flu-like symptoms, do not use the elevator. Keep a distance of 1. 5 meter from other riders. If the space is not enough, wait for the next turn ride or use the stairs. Don’ t touch the buttons with naked hands; Touch them with tissue paper or your elbow instead. Have disinfectant available and disinfect your hands before and after touching the buttons. Do not touch your eyes, mouth and nose after touching the buttons. Stay facing the walls of the elevator. Wash or disinfect your hands with warm water immediately after getting off the elevator in case of touching buttons. At the entrance of the clinic: Place posters, and stands with alarming and educational matters about COVID-19 disease. Screen all patients, as well as, companions for the signs and symptoms of COVID-19. Limit the entrance of companions to the clinic and not allow those who were exposed to COVID patients in recent two weeks. Get all patients to wear masks and disinfect their hands with alcohol based disinfectant solutions before entering the clinic. Waiting room: Limit the number of patients at the waiting room. The distance between patients should be at least two meters. Put partition between them if it is possible. Open the windows and doors 6-12 times per hour. Have disinfectant solutions in the waiting room and soap in the washing closet available to all patients. Cough etiquette: Cover your mouth and nose with tissue paper or your internal surface of your elbow in case of coughing or sneezing. Discard the tissues in dustbin after coughing or sneezing and wash your hands. Physician’ s room: Use a paperless system for transmitting data medical records between physicians and secretory or para clinics. The distance between physician and patient should be at least 2 meters. Physicians should change the gloves after each visit. The disposable table cloth should be changed and the table and all the surfaces touched by the patient should be disinfected after each visit. Follow up of patients at home: Patients at home should be first followed up regularly at daily basis and then setting up the frequency and duration of follow ups based on patient health condition. Personal protective equipment: Medical staff should wear full personal protective equipment including N95 Masks, goggles, face shields, gowns and gloves. Monitoring medical and allied health care staff: Signs and symptoms of COVID-19 should be monitored regularly and the test RT-PCR should be performed every 3 days for health care workers in close contact with suspected COVID-19 patients. Return to work place: Health care personnel could return to work from 10 to 20 days after onset of the disease, provided that symptoms have resolved and had been afebrile without the use of antipyretics for at least 24 hours. Donning and Doffing: Errors in donning and doffing have been observed even among experienced personnel. Therefore, the order of donning and doffing of personal protective equipment should be followed for prevention of infection. Nebulizers and aerosol producing procedures: Given dispersing the virus particles by nebulizers around 10 meters, nebulizers and aerosol producing procedures, should not be used routinely in clinics unless the patient is isolated, the doors closed, and the personnel out of the room. Conclusion: COVID-19 is a newly emerged and highly contagious disease. Its diagnosis is based on multiple signs and symptoms, as well as, laboratory and imaging findings. This disease has no approved treatment and all medications are used based on clinical trials so far. Therefore, the best practice policy is prevention. One of the available facilities that could help in prevention of the disease is telemedicine. Around 80% of patients, who have mild disease, could be followed up, quarantined and managed at home and managed by telemedicine. Those at home should be monitored daily and if their condition worsened need to be admitted to special centers dedicated to COVID-19 patients. They should not be referred to all clinics or admitted to all hospital wards. Unnecessary referrals lead to spread of the infection. Hospitals and clinics are already overloaded and medical personnel exhausted. Medical personnel, as national resources should be preserved for the remaining 20% of patients with moderate to severe disease. Since health care workers are exposed to the high load of the virus and they may receive the viral load from multiple sources, their disease is often more severe, the risk of mortality and the risk of transmitting the infection to others is higher than the general population. Therefore, providing them with full personal protective equipment and monitoring their health condition is essential.

Background and aims: Lead is ubiquitous and one of the earliest metals discovered by the human. This metal is widely used in different industries due to its important physico-chemical properties like softness, high malleability, ductility, low melting point and resistance to corrosion. Lead absorbed in body with several routs and when transfer in blood is primarily attached to red blood cells. Human exposure to this toxic metal and its compounds occurs mostly in lead related occupations and also non-occupational exposures can acccure. Lead and lead compounds are not beneficial or necessary for human health, and can be harmful to the human body. The health effects of lead are directly related to the concentration of lead in the affected organe. Lead can affect on various organs in the body and it is one of the causes of problems and health conditions, including effects on central nervous system and cuses anemia, abnormal behavior, depression, nausea, fatigue, Lead colic, high blood pressure, joint and muscle pain and HEADACHE. Also researchs show that Lead causes other health problems such as toxicity of the liver and kidneys system. Initial symptoms of lead poisoning are non-specific and some factors such as age, the amount of lead, whether the exposure is over a short-term or a longer period will influence what symptoms or health effects are exhibited. Due to the toxicity of this metal, it is necessary to investigate exposures of this toxic heavy metal in different environments. Lead exposure at mines is a concern therefore to determine the concentration of lead in air and blood samples of miners; air and blood sampling were down with specific methods. Another part of the study was the estimate of miners skin exposure that for this porpuse, DREAM (Dermal exposure assessment method) model was used. Methods: This study is a cross-sectional, descriptive-analytic research that was conducted on workers of a lead and zinc mine in Isfahan province. This research includes workers with at least one year of work experience. The oncentration of lead in the respiratory air of 46 workers was measured and of these, 40 blood samples were taken. In order to sampling and analysis of respiratory air samples, NIOSH7082 method was used that in this method for Lead sampleing the cellulose ester membrane filter was fitted into a holder and the calibrated individual sampling pump with a flow rate of 2 liters per minute was connected to the filter holder. After completion of the sampling, analysis was carried out using an atomic absorption spectrophotometere, flame. Biological monitoring of lead was performed on the basis of NIOSH8003 method after obtaining informed consent from the personnel and a complete explanation of the sampling steps. After collecting blood samples and preparing of them, analysis was performed using atomic absorption device. At the other stage of the research after extracting work information, the DREAM model was designed by the authors in Excel 2016 software. DREAM model, consists of an inventory and an evaluation part so the inventory part comprises a questionnaire with some modules consist of exposure, department(the observer indicates whether exposure to chemical or biological substances is likely to occur), company(general information on the company), job (job titles are defined and information on workers’ hygiene is obtained), agent (physical and chemical properties of substances are collected) and task(information is obtained on frequency and duration of task performance). Key items of the exposure module are assessment of probability and intensity of three dermal exposure routes: emission, deposition and transfer. Emission involves mass transport of substances by direct release from a source onto skin or clothing, deposition on skin or clothing describes mass transport from air, ransfer is defined as the transport of mass from contaminated surfaces onto skin or clothing. In DREAM model, exposure assessment for nine different body parts takes place at the task level to assessing both potential dermal exposure (Skin-PTASKBP) and actual dermal exposure (Skin-ATASK. BP). Potential dermal exposure is defined as exposure on clothing and uncovered skin, whereas actual dermal exposure is about exposure on skin. The potential exposure estimate (Skin-PBP) for a certain body part comprises the sum of dermal exposures due to three different exposure routes: emission (EBP), transfer (TBP) and deposition (DBP). Finally, after collecting data statistical analysis of the data was performed using SPSS 22 software and related statistical tests. Results: In this research the average age of mining workers is 35. 5 years, the average weight is 51. 72 kg and the mean of height is 172. 54 cm. According to the results of this study, mean blood lead in different age groups is not the same so that the level of blood leads in the age group of 22 to 38 years old was lower than the age group of 39 to 53years. The results of this study showed that the average blood lead of workers in mining tunnels was 24. 7μ g/dl ± 3. 36 and the average blood lead concentration of workers outside the tunnel was 23. 57μ g/dl ± 5. 80. The mean air lead of the respiratory region within the tunnels is 0. 0205 ± 0. 015 mg/m3 and the mean air lead of the respiratory air region outside the tunnels is 0. 0201 ± 0. 017 mg /m3. Independent T-test showed that workers were not homogeneous in terms of blood lead variable and there was a significant difference between the mean of blood lead (P <0. 001). Results show that although, with increasing work history, the level of blood lead in individuals has increased, but this increase is not statistically significant (P = 0. 224). Comparison of the results obtained from the control and main samples showed that the mean and standard deviation of blood lead in the main and control samples are 24. 5± 5. 43 and 17. 08± 3. 85 respectively. According to the results of the correlation test, there was no significant correlation between the Lead concentration of the respiratory air region, the concentration of leed in blood samples and the actual skin exposure that comes with the DREAM model with a significant level of p= 0. 806 and p= 0. 193, respectively. The mean of lead concentration in respiratory air was compared with occupational exposure limit in Iran so that the average results of the respiratory air lead were 0. 02 mg / m3, which is less than the limit specified. According to the results of this study, the mean blood lead of workers was 24. 5 μ g/dl which is less than biological exposure indices. DREAM model analysis show that 15. 2% of miners had a low exposure rating with lead, 4. 3% ranked average, 13% high, 37% very high and 30. 4% had very high exposure rating. Conclusion: Regarding the porpuse of this study, after careful observation of the process and the different sections and working areas, the level of Lead in the blood respiratory air were measured and analyzed. According to the results of this research workplaces are the most important factor in increasing and reducing blood lead. It is almost impossible to remove lead completely from the human body; therefore, reduction and prevention of lead exposure are very important. The use of appropriate personal protective equipment, the correct use of them, establishment of appropriate time table between drilling and extraction, the use of rubbing non-petroleum products are recommended in order to exposure control to lead. Occupational hygiene has traditionally focused on inhalation exposures to chemical and biological agents and during the last decade, dermal exposure assessment has received more attention. Different approaches are used to estimate dermal exposure that in this research DREAM model was used. Results show that DREAM model is flexible and can be used for dermal exposure characterization for all kinds of scenario and because of its hierarchical structure; it takes on average 15– 30 min only to assess exposure for one person carrying out one task. According to the present study the DREAM is a simple and inexpensive model which is well suited to investigate exposure to lead in the mine. This model supplies an estimate for exposure levels on the skin and outside clothing layer, and gives insight in the distribution of dermal exposure over the body of exposued workers to pollutants. In addition to the advantages, the model also has some limitations, for example since few studies have been done on skin exposures, the values are presented hypothetically. In order to expand this study and provide more definitive views on the DREAM model, it is recommended that in addition to measuring the concentration of lead in air and blood samples in different working conditions, researchers use skin sampling techniques and compare the results with this model. In this study researchers suggested that skin and clothing sampling methods be used to increase the accuracy of determining the amount of lead exposure to skin. Also, the identification and risk assessment of lead exposure in workplace is recommended to determine maximum and minimum of risk level.

Background and aims: Noise exposure as a main problem of industrial world is one of the most common risk factors in industries and many employees expose to it in the workplace. Noise exposure causes a wide range of the discomforts, disorders, and occupational diseases and effects including focus loss, systolic blood circulation changes, sleep disturbances, long-term memory loss, Anger, vascular problems, stress, HEADACHE, nausea, irritability, and irreversible hearing loss. Hearing loss in industrial environments is made due to the prolonged exposure with the high level sound pressures and considered as the agent of one third of occupational diseases in Europe. One of the most current and important industries with high level sound pressures in Iran is oil and gas industry. Iran has a special status in terms of oil and gas resources in the region and world, so that it is considered as the fourth crude oil producer, fifth crude oil exporter, and third country having oil reserves. This industry provides the material and energy to other industries and can play a substantial role in economics of developing countries. Abadan oil refinery is largest refinery of Iran and one of three largest refineries in the world. This refinery has been located in Khuzestan province of Iran and occupational noise in mostly its units has exposed the employees to adverse health effects. The results of various studies performed on physical harmful agents, particularly noise, in the oil and gas industry and related companies indicate that noise exposure in some their units is higher than acceptable limit in some units. Given the special status of oil industries and the high volume of labor forces in these industrial units, the present study was aimed to evaluate the workplace noise in operational units of reservoirs and petroleum products transportation of Abadan oil refinery and investigate the impact of control measures on the noise exposure. Methods: This cross sectional and analytical study, was carried out in the operational units of tanks and petroleum products transportation including Crude oil pumping stations 1, 2, and 3, pus oil pumping station, MTBE, Control Center, NTA, KTA, mixing and fusion, fuel transportation, spherical reservoirs, and mazut unit. At the first, the basic information including locations of noise sources and operating conditions of equipment in the various units were collected for determining the noise pollution and identifying the noise productive resources. Then, the values of the sound pressure level were measured using sound level meter, model CEL 490, made by Casella company based on ISO 9612 standard. As well as, the sound level meter was calibrated by the calibrator, model CEL-110/1. In addition, the noise characteristics of the productive resources were determined by ISO 3745 standard. Based on ISO 9612 standard, the studied units were divided to equal squares with the dimensions of five and five meters using a regular network measurement pattern and the centers of these squares were specified as the measurement points. Given that the noise variations were lower than five dB, the values of the sound pressure level were measured at least three times in each point and their mean were calculated as the sound pressure level of each point. The least time of noise measurement in each point was fifteen seconds. To identify the main noise productive resources and dangerous areas with high sound pressure level, the measurement results were depicted in the form of a noise plan. The mean values of air temperature and relative humidity during the measurements were 38 degrees of centigrade and 64 percent, respectively. As well as, wind speed was slow. Give the aim of study, network A was selected as sound level measurement weighting scale and mean height of sound level meter from ground surface was nearly 1. 55 ± 0. 175 meters. After identifying the main noise productive sources in the units, control measures including were determined and implemented based on the type of the noise source. The used control solutions included lubrication of moving parts, repairs, improvement of pumps foundations, reduction of exposure time, and, use of personal protective equipment during exposure to the noise. Based on the type of the noise source, one or combination of control solutions were used. And measurements were carried out in controlled areas. Finally, after performing control measures, the remeasurement of sound exposure in similar situations was carried out in units. In final, the noise measurements were repeated again after performing the control measures based on the stated method. Results: In total, 11 units were investigated in this study. The results of environmental noise pollution measurement in the operational units of reservoirs and petroleum products transportation showed that NTA unit with the mean sound pressure level equal to 89. 28 dB and spherical reservoir unit with the mean sound pressure level equal to 75. 33 dB have the highest and lowest values of the noise pollution, respectively. Based on the results, of 523 measured stations in the present study, 115 stations were with a sound pressure level more than 85 dB, 373 stations with a sound pressure level from 65 to 85 dB, and 30 stations with a sound pressure level less than 65 Db. Of the total measured stations, 71. 3 percent are in alert zone, 21. 9 percent in risk zone, and 5. 7 percent in safe area. NTA unit had the most number of the stations higher than 85 dB and KTA unit had the least number of the stations less than 85 dB. Of total stations with the sound pressure level higher than 85 dB, 19 percent was related to control center unit, 4. 54 percent related to KTA unit, 9. 37 percent related to crude oil pumping station 2, 27. 5 percent related to crude oil pumping station 3, and 34 percent related crude oil pumping station 1. The results determined that the control measures decreased the mean sound pressure level of crude oil pumping station 1 by 2. 39 dB, of control center unit by 1. 7 dB, of pus oil pumping station and MTBE units by 0. 89 dB, and of NTA by 0. 08 dB. As well as, the results of the measurements indicated that the sound pressure level of other units did not significantly change. Conclusion: The results showed that the highest and lowest values of the sound pressure level were related to NTA unit and spherical reservoirs unit, respectively. The most inappropriate stations with the high noise pollution were related to NTA unit. This unit have a great importance among studied units because of the number of people exposed to noise and the value of noise pollution. Given the environmental measurement results, units with a mean sound pressure level higher than 85 dB require the corrective actions, particularly technical engineering measures and effective control strategies, for the continuous improvement. Based on the measurement results, 115 stations have the values of the sound pressure level more than 85 dB. If the engineering and administrative control measures are not implemented, the exposure time should be reduced. The results of the present study indicated that the implementation of the low-cost control methods and the repair and maintenance of the equipment and devices can decrease the noise exposure. In addition, these control measures increase the mean allowable time exposure. These results suggest that the appropriate control measures can cause the optimal use of the workers and professionals in different occupations. Refineries are one of the industries that most parts of it produce the noise pollution. As well as, because of the number of employees, exposure to a variety of harmful agents, and difficult environmental conditions, the control measures such as engineering solutions in oil and gas refineries should be given more attention. To reduce the noise exposure in the operational units of reservoirs and petroleum products transportation, the following control solutions are proposed. The maintenance, repairs, and proper lubrication of the machinery and equipment will reduce the unwanted noise production. It should be noted that the machinery maintenance and repairs not only are necessary for the noise control, but also increase the useful life of the machinery. Vibration also is one of the noise productive sources. Vibration can be controlled using the appropriate foundation, rubber layers, and etc. This solution will reduce the sound pressure level generated by the vibration. As well as, the appropriately choice of the machinery or equipment reduces the level of the unwanted noise. The selection of the machinery with the most consistent and with the lower levels of the undesired noise production due to higher technology are considered as key factors in the strategies to minimize the unwanted noise. Prohibiting or restricting the use of the noise productive equipment can significantly diminish the unwanted noise. In addition, given to 12-hour planning of the staff shift work and the mean value of the sound pressure level in the operational units, job rotation can be effective. Finally, the hearing protective equipment as the latest solution of the unwanted noise control can be applied. If this control measures are correctly implemented, those can greatly reduce the noise pollution and ensure the increase of the employees’ health and productivity.

Introduction: The assessment of the problem of seizures requires knowledge of the clinical details and features of the seizures, the functional abnormality in the brain as shown on the EEG, and the structural assessment of the brain with an MRI study optimized for epilepsy. Usually MRI or computed tomographic (CT) scan should be performed in evaluating the cause of a newly diagnosed seizure disorder. MRI is preferred over CT because of its greater sensitivity and specificity for identifying small lesions.Because there is an option of surgical excision of the "seizure focus," which may cure the patient, the detection of a focal abnormality of the brain is important for the formulation of the reason for the seizures and the options available for treatment. Knowledge of the brain abnormalities early in the course of treating the patient greatly helps the management of each individual. The challenge to epileptologists is that the problem of epilepsy is a special one, which requires optimized protocols dedicated to it.MRI interpretation is different when used in a screening way and when viewed in the context of other investigations. This is particularly important when the patient has partial seizures and may be considered for surgical treatment.Most centers that deal with epilepsy spend a great deal of time in ensuring the quality of their EEG and EEG interpretation. However, unless there is a radiologist with an interest in epilepsy or an epileptologist who spends time with radiologist colleagues, it can be difficult to establish good epilepsy-focused MRI with appropriate sequences, radiography, and interpretation. MRI acquisition and interpretation need to be focused on the problem of epilepsy.IndicationThe American academy of neurology has published practice parameters for neuroimaging (NI) studies (MRI, CT) of patients having a first seizure. Emergent NI (scan immediately) should be performed when a health care provider suspects a serious structural lesion. Clinical studies have shown a higher frequency of life-threatening lesions in patients with new focal deficits, persistent altered mental status (with or without intoxication), fever, recent trauma, persistent HEADACHE, history of cancer, history of anticoagulation, or suspicion of acquired immunodeficiency syndrome.Urgent NI (scan is included in the disposition or is performed before disposition when follow-up of the patient's neurological problem cannot be ensured) should be considered for patients who have completely recovered from their seizure and for whom no clear-cut cause (e.g., hypoglycemia, hyponatremia, tricyclic overdose) has been identified to help identify a possible structural source. Because adequate follow-up is needed to ensure a patient's neurological health, urgent NI may be obtained before disposition when timely follow-up cannot be ensured. Additionally, for patients with first-time seizure, emergent NI should be considered if the patient is over 40-years of age or has had partial-onset seizures. RadiographyFor epilepsy protocol images, the orientation of the imaging plane must be according to "in-brain" landmarks. This means that the radiographer must understand the hippocampal axis and ensure that all imaging is in this plane. Because one will need to compare structures on the left and the right, the angulations of the imaging in the coronal plane must also be symmetric, based on in-brain landmark. Images can also be reconstructed in this appropriate axis from three-dimensional (3D) data sets. It is important that the epileptologist reviews the imaging and is satisfied with the quality of the imaging.InterpretationIt is important to identify suspicious as well as definitely abnormal areas. In the interpretation of the MRI in epilepsy, it is not enough to evaluate the images as "abnormal" or, by default, "normal." The diagnosis of "normal" should be an active and positive one. If there is any change that is suspicious but not definitely abnormal, the diagnosis of normal is not appropriate. This "in-between" assessment can be very important in deciding how further investigations progress.Even when imaging is excellent, the correct interpretation of subtle changes needs to be based on a clear understanding of the features of the abnormality that has been looked for. In the case of epilepsy, the major difficulty that confronts the radiologist, and the one with which the epileptologist must also be confident, is the reliable diagnosis of HS and subtle malformations of cortical development (MCDs).The features of HS are altered signal in a small hippocampus and loss of the normal internal architecture. Not any asymmetry is HS, and an abnormal signal in a large hippocampus is usually hippocampal dysplasia rather than sclerosis. If one only looks for atrophy or asymmetry, the wrong hippocampus may be diagnosed as abnormal.RequestsMRI is like the EEG in terms of requirements for basic study, sleep-deprived study, extra electrodes, or video-monitored study. One can acquire many different bits of information using MRI that gives different degrees of assessment of the brain. This also involves having the patient potentially in the scanner for a long time. Although basic MRI is needed in nearly all patients, further studies need to be clinically driven and aimed at solving a specific problem. The epileptologist needs to clearly understand what information is needed and what can be obtained. The more focused the question that is asked of the radiologist, the better focused the assessment of the images will be. This is often the weak link in the otherwise excellent MR imaging. Effort to focus the request is well rewarded and interpretation of an MR depends on the electroclinical findings and is assessed along with other examinations, such as video-EEG telemetry, positron emission tomography (PET), and SPECT.Typical Imaging Sequences for an Optimized Epilepsy ProtocolA typical clinical scanning protocol for a patient with refractory epilepsy may include T1-weighted imaging, T2-weighted imaging, FLAIR imaging, and 3D volume acquisition sequences. Imaging must be in hippocampal axis and good signal -to -noise ratio is as important as thin slices. The application of contrast agents is indicated if there is suspicion of a primary or metastatic tumor, infection, or inflammatory lesion. In epilepsy centers, it must be possible to diagnose hippocampal sclerosis with high sensitivity and specificity with visual analysis.One should think good "epilepsy MRI" not "MRI." To achieve this, knowledge of MRI is needed not only by the radiologist, but also by the neurologist and epileptologist. It is this continuing interaction that enables optimized imaging to be obtained.Quantification of Volumes and T2 Relaxometry in EpilepsyHigh-resolution T1-weighted 3D volume sequences can be used quantitatively to measure the volume of any particular regions of interest. In the case of epilepsy this is usually the hippocampus. Volumetric measurements require a significant investment in learning the hippocampal boundaries and depend on a large number of variables that need to be understood and controlled for in image analysis and acquisition. Volumetric assessment makes it possible to assess the progression of volumetric changes and may begin to help unravel the effects of the primary disease from the secondary effects of seizures. It can be performed manually or with half- or fully-automated software.T2 relaxometry is the quantitative determination of the T2 relaxation time. To achieve this, several T2-weighted images are acquired at different echo times, and in each voxel the resultant values are fit with an exponential decay curve to estimate the T2 decay rate of the imaged tissue. T2 relaxometry has been established as a reliable tool that is stable over time. In contrast to elaborate volumetric assessment, the T2 relaxometry is a quick technique with small variance and can be implemented in large-scale studies.In epileptic patients with HS, signal increase on T2-weighted images is typically observed in the hippocampus. The measured values of the hippocampal volume and the T2 time are correlated with each other, indicating that a marked volume loss is associated with a significant increase in T2 relaxation, reflecting the complex pathology which is HS.Diffusion-Weighted ImagingA diffusion-weighted signal reflects the molecular motion of water in the extra- and intracellular environments. Diffusion-weighted MR techniques are frequently used to assess early signs of cerebral ischemia. Diffusion changes similar to those observed in ischemia may also be present in tumors or infection.Summary and ConclusionsMRI studies are an essential component of the overall assessment of why a patient has epilepsy. This requires us to define and understand the epileptic events, the structural abnormalities in the brain, and the clinical context in which seizures occur. Unless high-quality information is obtained in all three of these domains, the basis of epilepsy in any individual has not been fully assessed.In this article, we have dealt with the need to define and understand the structural brain abnormalities by acquiring appropriate epilepsy-focused MRI of high quality and diagnosing the important lesions with high sensitivity and specificity because this is fundamental to good epileptology, albeit often difficult to implement in practice. The clinical context, seizure features, and interpretation of the imaging, with full knowledge of the hypothesized basis of each individual's epilepsy and the other investigations, are the key to the proper use of imaging.