Pelvic mass due to transmigrated IUD

Intrauterine device (IUD), a conventional method of contraception is rarely associated with uterine perforation and extra uterine dislocation. A 29 years old woman complaining of vaginal bleeding was referred for pelvic mass identified in ultrasound. The mass was confirmed with CT scan. In laparatomy we found an IUD in cul-de-sac and pelvic mass was apparently an organized hematoma. Transmigrated IUD can induce organized hematomas presenting as a pelvic mass.     

Antimicrobial resistance of nosocomial strain of Acinetobacter baumannii in Children's Medical Center of Tehran: a 6-year prospective study

There are increasing reports of emergence of multiple drug resistant (MDR) Acinetobacter spp in the world; however there are a few reports in our country. 145 A. baumannii isolates from distinct wards and Children's Medical Center (CMC) in Tehran were studied in order to find the profile of antibiotic resistance among them. 40.6% (59/145) of A. baumannii isolates were identified as MDR. Overall susceptibility rates to cotrimoxazole, chloramphenicole and ciprofloxacin were 23.4%, 16.9% and 20.1%, respectively. Frequency susceptibility rates to amikacin, kanamycin, gentamycin and tobramycin decreased gradually from 81.2%, 50%, 50% and 62.5% in 2002 to 25%, 15.6%, 28.1% and 25% in 2007 respectively. Overall susceptibility rates to cephalosporines cephalotin, ceftazidime, cefteriaxon, ceftizoxime and cefixime were 9.3%, 14.7%, 16.2%, 15.9% and 18%, respectively. Susceptibility to carbapenems was assessed only in 2007. The susceptibility rates of Imipenem and meropenem were shown to be 50% and 46.8%, respectively. Our data indicates that MDR A. baumannii strains are spreading and carbapenem resistance is becoming more common in Iran. Our findings also highlight the importance of clinicians' access to updated susceptibility data regarding A. baumannii in developing countries such as Iran.     

Prevalence of hepatitis A virus infection in a HIV positive community

Hepatitis A is acute and usually self-limiting disease, but sometimes it can be dangerous such as in immunosuppressed patients. Purpose of this study is to investigate the prevalence of hepatitis A serology in HIV/AIDS Patients. 247 HIV positive patients from March 2005 to September 2006 were entered in this study. Participants completed questionnaires to elicit demographic, drug and sex risk information, and were (tested for hepatitis A. They were all referred to Counseling center for behavioral diseases in Imam Khomeini Hospital. Cases were chosen from volunteers with no history of jaundice or acute hepatitis. Data were analyzed by SPSS version 13 and results were compared between seropositive and seronegative groups using T test and chi square. Statistical significance was accepted at a level of P < 0.05.200 (80.98%) were male and 47 (19.02) were female. The mean age was 36 +/- 9.3. 238 (96.3%) of patients were seropositive. One hundred percent and 96% who were born in rural and urban areas were seropositive, respectively. Also, 85.7% and 96.6% who reside in rural and urban areas were seropositive, respectively. Iran is an endemic country for hepatitis A in which most people has asymptomatic infectious during childhood. According to high prevalence of hepatitis A positive serology in HIV/AIDS patients, routine vaccination seems to be unnecessary. But special sub populations like HIV infected infants should be evaluated more precisely and different approaches may be needed for them.     

Analysis of RAB27A Gene in Griscelli Syndrome type 2: Novel Mutations Including a Deletion Hotspot

INTRODUCTION: Griscelli syndrome type 2 is an autosomal recessive disorder characterized by pigmentary dilution and occurrence of acute phases of hemophagocytosis. The disease is caused by mutations in RAB27A gene, coding a small GTPase involved in terminal phases of cytotoxic granule/melanosome exocytosis. MATERIALS AND METHODS: We describe the result of mutation analysis among nine patients from seven non-related Persian families. We present four novel mutations including a deletion hot spot (514del 5). CONCLUSION: This hot spot is flanked by "direct repeats" of nucleotides, which are previously shown to be associated with areas of recurrent small deletions.     

Para Vertebral Abscess and Rib Osteomyelitis due to Aspergillous Fumigatus in a Patient with Chronic Granulomatous Disease

Chronic granulomatous disease is an infrequent primary immunodeficiency characterized by defective intracellular killing of ingested microorganisms thereby making patients highly susceptible to recurrent lite threatening bacterial and fungal infections. In this study, we review the medical course of an 8 yrs old girl with AR-CGD. She suffered from recurrent dermal and deep abscesses, retractable salmonellosis, disseminated BCGosis, recurrent aspergillus infection presenting as mandibular osteomyelitis and pulmonary involvement with invasion to rib and vertebral bodies. Despite of longterm IV amphotricin B, itraconazole and IFN-gamma administration, and surgical interventions (drainage and resection), she died in spite of long term antibiotic anti fungal prophylaxis and interferon-gamma administrations, invasive aspergillosis resistant to current conventional therapies is the cause of 1/2 to 1/3 of CGD deaths.     

Metacarpal cortical area and risk of coronary heart disease: the Framingham Study

The objective of this study was to determine the relation between bone mass and the incidence of coronary heart disease in women and men. Participants included 2,059 cohort members of the Framingham Study (1,236 women and 823 men aged 47-80 years) who underwent posteroanterior hand radiography and were free from cardiovascular disease at baseline (1967-1970) and who were then followed for 30 years through the end of 1997 for the incidence of coronary heart disease. The incidence of coronary heart disease decreased from 15.65/1,000 person-years among women in the lowest metacarpal cortical area quartile to 11.76/1,000 person-years among women in the highest quartile (p(trend) = 0.03), and the inverse relation persisted after adjustment for confounders (highest vs. lowest quartile of metacarpal cortical area: hazard ratio = 0.73, 95% confidence interval: 0.53, 1.00; p(trend) = 0.03). In contrast, no association was present in men (highest vs. lowest quartile of metacarpal cortical area: hazard ratio = 1.14, 95% confidence interval: 0.84, 1.56; p(trend) = 0.55).     

Antimicrobial susceptibility and synergy studies of Burkholderia cepacia complex isolated from patients with cystic fibrosis

Susceptibility (18 antimicrobial agents including high-dose tobramycin) and checkerboard synergy (23 combinations) studies were performed for 2,621 strains of Burkholderia cepacia complex isolated from 1,257 cystic fibrosis patients. Minocycline, meropenem, and ceftazidime were the most active, inhibiting 38%, 26%, and 23% of strains, respectively. Synergy was rarely noted (range, 1% to 15% of strains per antibiotic combination).     

Factors influencing success rate of leukocyte immunization and anti-paternal antibodies in spontaneous recurrent miscarriage

PROBLEM: Paternal leukocyte immunotherapy has been used as treatment for spontaneous recurrent miscarriage; however, controversies have raged against the factors influencing its success. METHODS: Five hundred and forty-nine women with three or more unexplained pregnancy losses were offered immunization. Two weeks after the second immunization, serum was tested for anti-paternal cytotoxic antibody (APCA) by cross matching and if revealed positive she was advised pregnancy. Meanwhile, decision trees have been developed by Waikato Environment for Knowledge Analysis package to predict factors influencing APCA production and pregnancy. RESULTS: Of 549 subjects, 93 (16.9%) revealed to have positive APCA, among whom 49(52.7%) had clinically successful pregnancy (> or =28 weeks). Patient's age, consanguinity between couples and previous history of surgery, and infectious, endocrine, immunologic, uterine and cervix disorders were inversely associated with APCA production and clinically successful pregnancy, whilst, number of children was a potent positive predictor. CONCLUSION: Leukocyte immunization could be borne in mind as a therapeutic approach in selected subjects. Younger females with negative past medical history who are not frequent aborters are more likely to take benefit from this therapeutic approach if they do not have any familial relationship with their spouse.     

An evaluation of the effects of an angiotensin receptor blocker on health-related quality of life in patients with high-normal blood pressure (prehypertension) in the Trial of Preventing Hypertension (TROPHY)

The Trial of Preventing Hypertension (TROPHY) demonstrated the feasibility of possibly reducing the incidence of hypertension with the angiotensin receptor blocker candesartan compared with placebo. The long-term benefits of pharmacologic therapy in high-normal blood pressure, or prehypertension are not known, and the long-term effect on health-related quality of life (HRQL) has not been determined. An analysis of covariance model was used to assess treatment differences from baseline in the HRQL scores using Short Form (SF)-36, and component measures at subsequent visits. Of the 809 randomized patients, 734 had both baseline and > or =1 HRQL follow-up assessment: 95% (379 of 397) of patients receiving candesartan and 91% (355 of 388) of patients receiving placebo. There were no statistically significant between-group differences in least-squares mean physical component survey and mental component survey scores or the individual scales at each scheduled visit relative to baseline values (P >.05). In TROPHY, patients with prehypertension had relatively high baseline HRQL, and HRQL was maintained with the angiotensin receptor blocker candesartan over both the 2-year treatment period and a total 4-year trial period.