Shiraz E-Medical Journal
Year:2007 | Volume:8 | Issue:4|Papers Count:6

Mucoromycosis is common term used to different clinical manifestation caused by fungi of order Mucorales. Almost always aggressive forms of infection manifest in immunocompromised hosts and several organs can be infected. We report the case of an immunocompromised patient with an aggressively progressing, painful non-traumatic ulceration and poorly responsive to standard treatment.

Backgrounds: In the perioperative setting, pulmonary hypertension is due to ischemia, left-sided valvular regurgitation and stenosis, residual shunt, pulmonary emboli, pericardial effusion etc. The pulmonary artery (PA) pressure can be assessed by different methods, including invasive pulmonary catheters and pulsed Doppler echocardiography. Because of limitations of Doppler echocardiography (conventional method) for evaluation of PA pressure, we purposed this study to determine whether tricuspid annular plane systolic excursion (TAPSE), isovolumic relaxation time (IVRT) and S-wave velocity obtained by tissue Doppler imaging (TDI) can be used as indices of systolic pulmonary artery pressure in perioperative setting.Materials and Methods: Simultaneously, TAPSEby 2-D echocardiography and tissue Doppler velocity (TDV) study by Doppler echocardiography and right heart catheterization by Swan-Ganz catheter wereperformed in 55 patients (mean age 46 years,30 were male) withleft–sided valvular disease (n=25), ischemic heart disease (n=18) and adult-congenital heart disease (n=12).The TAPSE index ,which is expressed as an absolute value (cm or mm), IVRT and S-wave velocityby TDI were measured. We also measured pulmonary artery systolic pressure by right cardiac catheterization.Results: In patients with moderate and severe pulmonary hypertension (PASP>45mmHg) the TAPSE value was < 17.8 mm with sensivity of 90% and specifity of 80%, the S-wave velocity was <11cm/s with sensivity of 90% and specifity of 86% and the IVRT was >79ms with sensitivity of 93% and specificity of 95% (p<0.001). Some factors such as underlying diseases (ischemic heart disease, congenital heart disease) had no effect on this correlation.Conclusion: We conclude that evaluation of TAPSE index and IVRT and S-wave velocity by echocardiography provides a simple and rapid method for estimating systolic pulmonary artery pressure in perioperative setting.

Background: Diabetes Mellitus (DM), the most common endocrine disease, is characterized by metabolic abnormalities and by its long term complications.It is well known that genetic predisposition is an important factor in occurrence of diabetes mellitus but the mechanism of inheritance of this disorder is unclear. The more significance of maternal or paternal inheritance in diabetes has been a matter of controversy and difference in various populations and races, so this study was conducted to evaluate pattern of inheritances in Fars diabetes center referrals as a Southern Iranian population.Materials and Methods: In this study 1056 diabetic patients in Fars diabetes center were interviewed by trained interviewers using a standard questionnaire and information about family history of 1st and 2nd degree relatives of patients were recorded.Results: In this study type II diabetes had more familial aggregation than type I diabetes (p <0.001). Maternal transmission of diabetes was stronger in type II diabetes than type I (p<0.001). Positive family history of diabetes in 2nd degree relative of type I patients was significantly more common that type II diabetic patients (P<0.001). Maternal history of diabetes is stronger than paternal history of diabetes among both type I and type II diabetic populations (type I P<0.05 and type II P<0.001).

Introduction and Purposes: Cerebrovascular accident (CVA) is the third leading cause of death worldwide. The most common cause of CVA is obstructive lesions of the proximal internal carotid artery, for which a variety of surgical and nonsurgical therapeutic modalities have been proposed.In the surgical approach (carotid endarterectomy) several different methods have been employed for arterial repair which include primary repair, synthetic or autologous venous patches and eversion endarterectomy. These different methods have led to different outcomes in terms of postoperative arterial diameter and the development of restenosis.The present article aims at studying the changes in internal carotid artery diameter after primary repair in patients undergoing carotid endarterectomy in shohada-e Tajrish medical center, vascular surgery department.Materials and Methods: A descriptive cross-sectional clinical study was carried out on 42 operations of carotid endarterectomy performed on 36 patients (Six patients were operated on bilaterally). Arterial repair was uniformly performed by primary repair. The diameter of the artery was exactly measured by a special caliper before and after the operation. Follow-up assessment was performed by color Doppler ultrasound 6 months after surgery. Any variation in the arterial diameter or development of restenosis was recorded in individual questionnaires and results were statistically analyzed.Results: In 42 primary repairs of internal carotid artery we had an increase in post operative arterial diameter in 40.5% of cases with a mean increment of 3.17 percent. In 14.2 percent there was no change and in45.3 percent the arterial diameter decreased with a mean of 2.8 percent. Statistically the latter figure was not considered significant based on a T-test study.Follow-up color Doppler ultrasound performed 6 months after the operation revealed a stenosis up to 25% in 22.7% of patients which was not statistically significant.Conclusion: This study shows that primary repair of internal carotid artery after carotid endarterectomy does not result in narrowing or recurrent stenosis and therefore could be considered as a safe and satisfactory method of arterial repair. However, the authors recommend further controlled trials to compare this practice with the other methods of arterial repair.

Background and Aim:Health care workers (HCWs) in developing countries are at risk for nosocomial tuberculosis (TB). In this study, we are going to determine the prevalence ofTB infection among HCWs in Imam Khomeini hospital of Uremia, northwestern Iran.Materials and Methods: It is a cross sectional study, conducted between April and June 2004. Tuberculin skin test (TST) survey was conducted among 350 HCW, and measured the indurations size.Results: From 350 participants, 71 (20.28%) had indurations between 10-15mm and 96 (27.42%) had indurations more than 15mm. Most of HCWs with indurations more than 15mm were in age of 20-30 years. From 75 HCWs with employment duration of more than 10 years, 45(47%) had indurations of more than 15mm.Conclusion: PPD reaction in HCWs was higher comparison with control group, meaning this group are at high risk for Acquired TB.

Introduction: Cutaneous leishmaniasis is endemic in Iran. Fasa region (Southern west of Iran) is one of the hot spots. The most popular drug for treatment of cutaneous leishmaniasis is glucantime. Aims: To study the therapeutic and adverse effects of Glucantime in cutaneous leishmaniasis patients and also comparing the intramuscular and intralesional administration routes.Methods and Material: All new cutaneous leishmaniasis cases (880) that were diagnosed within two years of study were ruled in. Intralesional injection was used for solitary non-facial wounds, for maximum of 10 doses, injected every other day. For multiple lesions or facial lesions, intramuscular injection was performed, in daily manner for maximum of three 10 day periods, apart by 10 days of drug free intervals. Injections were done according to WHO guidelines. Results: The recovery rate was 84.03 % and 75.98% in intramuscular and intralesional injection groups, respectively. The most common side effect was skin hypersensitivity and urticaria, which was more seen in those with intralesional injection (10.92% in comparison with 2.59% in IM group). No cardiac or renal complication was observed. Conclusions: Complete recovery is higher in intramuscular injection compared to intralesional injection of Glucantime for cutaneous leishmaniasis. Side effects are also less seen in the intramuscular injection.