IRANIAN JOURNAL OF MEDICAL SCIENCES (IJMS)
Year:2012 | Volume:37 | Issue:2|Papers Count:11

In 1988, the Centers for Disease Control and Prevention (CDC) published two articles on nosocomial infections (NIs) and certain types of NIs’ criteria for surveillance purposes. Nosocomial infections refer to any systemic or localized conditions that result from the reaction by an infectious agent or toxin.

Organophosphorous compounds have been employed as pesticides and chemical warfare nerve agents. Toxicity of organophosphorous compounds is a result of excessive cholinergic stimulation through inhibition of acetyl cholinesterase. Clinical manifestations include cholinergic syndromes, central nervous system and cardiovascular disorders. Organophosphorous pesticide poisonings are common in developing worlds including Iran and Sri Lanka. Nerve agents were used during the Iraq-Iran war in 1983-1988 and in a terrorist attack in Japan in 1994-1995. Following decontamination, depending on the severity of intoxication the administration of atropine to counteract muscarinic over-stimulation, and an oxime to reactivate acetyl cholinesterase are indicated. Supportive and intensive care therapy including diazepam to control convulsions and mechanical respiration may be required. Recent investigations have revealed that intravenous infusion of sodium bicarbonate to produce mild to moderate alkalinization is effective. Gacyclidine; an antiglutamatergic compound, was also proved to be beneficial in conjunction with atropine, pralidoxime, and diazepam in nerve agent poisoning. Intravenous magnesium sulfate decreased hospitalization duration and improved outcomes in patients with organophosphorous poisoning. Bio-scavengers including fresh frozen plasma or albumin have recently been suggested as a useful therapy through clearing of free organophosphates. Hemofiltration and antioxidants are also suggested for organophosphorous poisoning. Recombinant bacterial phosphotriesterases and hydrolases that are able to transfer organophosphorous-degrading enzymes are very promising in delayed treatment of organophosphorous poisoning. Recently, encapsulation of drugs or enzymes in nanocarriers has also been proposed. Given the signs and symptoms of organophosphorous poisoning, health professionals should remain updated about the recent advances in treatment of organophosphorous poisoning poisonings.

Background: The health transition in India reflects the growing burden of cardiovascular diseases. It is well-known that there are significant and meaningful differences in the measured electrocardiogram (ECG) parameters between females and males. Specific to ECG diagnosis and ischemia, reports have indicated a higher number of false positive results in female patients than in male patients. This study was aimed at examining gender difference in the prevalence of ECG abnormality in older people who were free of coronary heart disease (CHD) and its associated risk factors.Methods: This study was conducted in Solapur city using 400 apparently healthy asymptomatic subjects with an age range of 45 to 74 years. A resting 12-lead ECG was recorded in supine position in accordance with classical recommendations. The various ECG abnormalities were defined according to Minnesota code. The findings were analyzed using Chi Square test at P<0.05.Results: Out of 400 ECGs recorded, 152 showed abnormalities. The prevalence of ECG abnormalities was significantly (P<0.001) more in males than in females. Major prevalence of ECG abnormalities in males observed were LAD, LVH, sinus bradycardia, LBBB and Q/QS patterns. There was no significant gender difference in the prevalence of other ECG abnormalities.Conclusion: This study has outlined the overall prevalence of ECG abnormalities in males as well as in females in Solapur city. We found highly significant (P<0.001) increase in the prevalence of ECG abnormalities in males as compare to females.

Background: The rate of nosocomial infection appears to depend on whether it is calculated using the Center for Disease Control (CDC) or carrier state criteria. The objective of this study was to differentiate between primary endogenous (PE), secondary endogenous (SE) and exogenous (EX) infections, and to compare this classification with CDC criteria for nosocomial infections.Methods: Children hospitalized for more than 72 h at pediatric intensive care unit during 2004–2005 were enrolled. Children, who had the infection before the admission, and or did not develop an infection within the hospitalization were excluded. Surveillance samples were sampled on admission, and then twice a week. Diagnostic samples were obtained when infection was suspected based on the clinical condition and laboratory findings. Infections were evaluated as PE, SE and EX, and their incidences were compared with CDC criteria for nosocomial infections.Results: One hundred seventy eight patients were enrolled in the study. Forty-four patients (24.7%) develop infection. Twenty-seven patients (61.3%) had PE, 10 patients (22.7%) had SE, and 7 patients (15.9%) had EX infection. Secondary endogenous and EX infections are considered as nosocomial, thus 17 patients (38.6%) had a nosocomial infection. Thirty-one patients (70.5%) met CDC criteria for nosocomial infections. Seventeen patients (55%) were classified as PE, and 14 patients (45%) as SE or EX infections.Conclusion: Seventy percent of infections (31 out of 44 patients) met the CDC criteria for nosocomial infections, but only 39% of infections (17 out of 44 patients) were classified as nosocomial based on carrier state classification.

Background: The touch preparation technique is an accurate and rapid method, and when used as intraoperative consultation examination technique it preserves a good amount of tissue for paraffin embedded sections. This study aimed at examining the accuracy of the touch preparation technique by comparing its diagnosis with that of final pathological diagnosis made by microscopic examinations.Methods: The diagnoses of 139 central nervous system lesions by touch preparation technique and paraffin-embedded sections were compared.Results: Touch preparation technique diagnosed correctly 118 (84%) of the lesions. However, the technique failed to correctly diagnose 12% of the cases. The highest rate of accurate diagnosis (100%) was observed in five types out of 11 types of tumor examined. However, the technique was not able to diagnose hydatid cysts correctly.Conclusion: The findings indicate that touch preparation technique may be useful in diagnosing tumor type during surgical operations. Touch preparation technique is very accurate for intraoperative diagnosis. However, adequate clinical history, neuroimaging details, and the intraoperative impressions of the neurosurgeons, if provided, help the pathologists to improve the diagnostic accuracy of the technique.

Background: The traditional methods of studying the gene-environment interactions need a control group. However, the selection of an appropriate control group has been associated with problems. Therefore, new methods, such as case-only design, have been created to study such interactions. The objective of this study was to compare the case-only and case-control designs using data from patients with breast cancer.Methods: The interaction of genetic and environmental factor as well as the ratio of control to population odds ratio was calculated for case-only (300 patients with breast cancer) and case-control (300 cases of breast cancer and 300 matched controls) designs.Results: The confidence intervals and -2log likelihood in all variables in case-only design was smaller than those in the matched case-control design. In case-only design, the standard errors of some variables such as age at menarche, the first delivery at the age of 35 yrs and more or no delivery, the history of having live birth, use of oral contraception pills, breastfeeding history were less than those in the matched case-control design.Conclusion: The findings indicate that the case-only design is an efficient method to investigate the interaction of genetic and environmental factors.

Background: Brucella abortus is a gram-negative facultative intracellular bacterium that can cause a highly contagious disease in sheep, goats, cattle and one-humped camels. It is responsible for one of the most important zoonosis in human. The aim of this study was to evaluate the role of Mentha piperita, Origanum majorana, Citrus lemon, Cinnamomum verum and Myristica fragransessential volatile oil extracts on human macrophages infected byB. abortus 544.Methods: Essential volatile oil extracts from M. piperita, O. majorana, C. lemon, C. verum and M. fragrans were extracted. Human macrophages were cultured at a density of 2×105 cells per well in sterile 96-well microtiter plates, and infected with B. abortus 544 at a ratio of 1: 100 bacteria/cell. Then essential volatile oil extracts were added at a concentration of 1%. At specified times; cells were washed, lysed with 0.1% Triton, and plated on 2YT agar to determine the number of intracellular bacteria.Results: Cinnamomum verum volatile oil at a concentration of 1% had the highest antibacterial activity against B. abortus 544 inside human macrophages. Its inhibitory effect observed from 24 h and continued till 144 h after the infection. Moreover, C. verum (0.1%) in combination with 1% concentration of M. piperita, O. majorana, C. lemon or M. fragrans volatile oil extracts produced a synergistic inhibitory effect against B. abortus 544.Conclusion: The results indicate that, among the five selected oil extracts, C. verum volatile oil applied either separately or in combination with other oil extracts had the most effective antimicrobial activity against Brucella.

Background: Carcinomas of esophagus, mostly squamous cell carcinomas, occur throughout the world. There are a number of suspected genetic or environmental etiologies. Human papilloma virus (HPV) is said to be a major etiology in areas with high incidence of esophageal carcinoma, while it is hardly detectable in low incidence regions. This study was designed to evaluate the prevalence of HPV in esophageal squamous cell carcinoma (ESCC) cases diagnosed in Pathology Department, Medical School, Shiraz University of Medical Sciences.Methods: DNA material for PCR amplification of HPV genome was extracted from formalin-fixed paraffin-embedded tissue blocks of 92 cases of ESCC, diagnosed during 20 years from 1982 to 2002. Polymerase chain reaction was performed for amplification and detection of common HPV and type specific HPV-16 and HPV-18 genomic sequences in the presence of positive control (HPV-18 and HPV positive biopsies of uterine exocervix) and additional internal controls i.e. beta-globin and cytotoxic T lymphocyte antigen 4 (CTLA4).Result: Good amplification of positive control and internal controls was observed. However, no amplification of HPV genome was observed.Conclusion: There is no association between HPV infection and the development of esophageal squamous cell carcinoma in the cases evaluated.

Fungal infections of the gastrointestinal tract are not common in children, especially in immunocompetent ones. In this case report we describe a child who was presented with abdominal pain and mass, bloody diarrhea and fever. He was treated for amebiasis, but due to treatment failure and deterioration of his condition, he underwent a laparatomy. Histologic examination of the excised bowel in the second look revealed Basidiobolomycosis, a fungus belonging to the order Entomophthorales. The signs, symptoms, treatment and diagnosis of the present case indicate that fungal infections must be considered not only in immunocompromised patients with abdominal pain and mass, but also in apparently immunocompetent ones.

Nephrogenic adenoma is a rare benign lesion of bladder that may be confused with malignant lesions. There is a strong relation with urinary tract irritation and intravesicle instrumentations. Nephrogenic adenoma was initially thought to originate from urothelial metaplasia; however, no solid proof is available. We present a case of 55-year-old lady with urinary problem. Cystocopic examination showed a sessile mass, and biopsy revealed circumscribed proliferation of tubules, cysts, and papillae that were lined by low cuboidal to columnar epithelial cells. Nephrogenic adenoma can be a significant diagnostic pitfall due to the presence of certain histological features such as the presence of enlarged nuclei with prominent nucleoli. Immunohistochemistery study was strongly positive for CK7, P504S, CD10, and EMA, but negative for CK20, PSA, and P63.

Dear Editor: Endotracheal intubation (ETI) is a simple, rapid, safe and non-surgical technique for airway management. It maintains airway patency, protects the lungs from aspiration, and permits leak-free ventilation during mechanical ventilation. The anesthesiologists’ knowledge, technical skills and crisis management capabilities play an important role in controlling the occurrence of unwanted complications during airway management. In anesthesiology, leaking cuff is one of the problems occurring after correct endotracheal intubation. It usually occurs when the cuff is damaged by contact with teeth, nasal bone or Magill forceps during mechanical ventilation in which the tracheal tube should be removed and replaced. In patients with impossible manipulation of the neck, injuries to the cervical vertebrae of their neck, or difficult intubation, it is necessary to use a fiberoptic bronchoscope for reintubation most of the times. Direct laryngoscope with Macintosh blade for intubation is the first selection in cases of difficult intubation. Using laryngoscope produces reflex sympathetic stimulation, and subsequently increases heart rate, blood pressure, intracranial pressure, myocardial ischemia, and cardiac arrhythmia. Complications of airway problems often result in morbidity and mortality in anesthesia. Inadequate cuff seal is common and leads to hypoventilation during mechanical ventilation and aspiration of gastric contents.