An ultrastructural investigation of the blood neutrophils in camel (Camelus dromedarius)

Evaluation of camel neutrophil's structure and ultrastructure is essential for fundamental and applied research on innate immunobiology. There is little information on camel neutrophil's ultrastrucure. Healthy camel blood neutrophils were isolated, prepared, and stained for light, scanning, transmission electron microscopy, and organelles' biometry. We observed that (1) the nuclei of healthy camel neutrophils were highly lobulated, predominantly ≥5 lobules/nucleus, with euchromatin and hetrochromatin portions and very low ratio of nucleus to cytoplasm, (2) surface of neutrophils contained many psuedopods, and (3) the cytoplasm contained enormous granules with different sizes and forms and high density at the center, as well as with many different organelles such as abundant mitochondria, rough endoplasmic reticulum, microtubules, phagolysosome, vacuoles, and Golgi apparatus. Biometric analyses of key organelles in neutrophils also shed some new lights on the features of camel neutrophils. This ultrastructural study emphasizes the notion that camel neutrophils are highly equipped with the cytoskeletal machinery for efficient organelle movement, phagocytosis, and microbicidal activities. The ultrastructural features of camel neutrophils observed in this study would be outstandingly comparable to the neutrophils of other ruminants and needs further detailed comparative study.     

A five-year survey for dental malpractice claims in Tehran,Iran

ObjectivesDentists, like other doctors, can face punitive and legal consequences if patients are not satisfied with the dental treatment. The purpose of this study is to provide a database for dental malpractice claims in Tehran.MethodsWe conducted a retrospective study of dental malpractice claims In Tehran, between 2002 and 2006, based on the decisions of expert committees in medical malpractice cases by Tehran’s Legal Medicine Organization and Islamic Republic of Iran’s Medical Council.ResultsDuring these 5 years, 412 decisions related to dental malpractice were made. The majority of complaints were in fixed prosthodontics and oral surgery and also most of them concerned the private sector. Most of the cases were against general dentists. In the 56.7% of clinical cases and 40% of non-clinical cases of malpractice claims, dentists were found faulty.ConclusionsLike all other medical staff, dentists are under the obligation to comply with the legal rules in the country they practice. They also have to consider ethical principles as well as the acceptable standards and protocols of diagnosis and treatment. These data can alert them to the need for greater care and ethical professionalism when treating their patients.     

Hirschsprung's Disease: a Clinical and Pathologic Study in Iranian Constipated Children

Objective

Hirschsprung''s disease (HD) is a complex disorder resulting from absence of ganglion cells in the bowel wall leading to functional obstruction and bowel dilatation proximal to the affected segment. The aim of our study was to evaluate rectal biopsies from constipated children in different age groups to see in which age it is more likely to encounter HD to avoid unnecessary rectal biopsy.

Methods

Records of all children with chronic constipation undergoing a rectal biopsy to exclude HD were obtained from the files of Children''s Medical Center in Tehran, Iran. A detailed retrospective demographic review, including age of beginning of signs and symptoms was made of all cases.

Findings

Totally, 172 biopsies were taken from 168 children in a five year period, of which 127 cases (75%) had HD. The mean age of constipated patients at biopsy was 39 months and the mean age of patients with proven HD was 18 months. Males were affected more than females. Congenital anomalies associated with HD were found in 9.6%. In 85 (91%) cases constipation had begun in neonatal period.

Conclusion

Our data supports previous studies that if constipation begins after the neonatal period, the child is unlikely to have HD. In neonates delay in meconium passage is the most important clinical sign of HD.     

Urethral triplication and urethrovasal reflux in 5-day-old male infant

To present the case of a 5-day-old male infant referred to our clinic with complaints of huge swollen testes, recurrent urinary tract infection, and diarrhea. The imaging studies and surgical assessments revealed a urethrorectal fistula and 2 nonfunctional urethras. Cutaneous vesicostomy was performed urgently to avoid additional renal infection. At the age of 6 months, the anterior anal insertion was repaired by perineal access. Eventually, urethral reconstruction was performed when the boy was 3 years old. The patient was asymptomatic at the last follow-up examination without additional urinary tract infections. The combination of urethrovasal reflux and congenital urethral triplication, consisting of urethrorectal fistula, has not been previously reported.     

The treatment of a dural carotid cavernous fistula (CCF) using Onyx via a transorbital approach: a technical note

We report the successful case of embolisation of a Barrow D (White et al. in Am J Neuroradiol 28:1415–1417, 2007) dural carotid cavernous fistula (CCF) with bilateral external carotid artery and internal carotid arterial supply, using a direct percutaneous transorbital approach with the embolic agent Onyx. In particular, we highlight the properties of Onyx which make it suitable to treat the multi-compartmental nature of CCFs. The patient developed transient complications which may be related to the volume of embolic agent used, and we discuss this point further. This is still a developing technique, and we present our case as a technical note to aid those contemplating embolisation via a transorbital approach with Onyx.     

Huge immature teratoma of the liver in an adult: a case report and review of the literature

Teratoma tumors are tumors of childhood and, to the best of our knowledge, only 9 cases of hepatic teratoma and 1 case of immature teratoma of the liver had been reported in adults in the English literature. We present the second case of immature liver teratoma in a 22-year-old woman who presented with a 4-month history of abdominal pain and fullness sensation. A computed tomography (CT) scan of the abdomen and pelvis showed a huge well-defined heterogeneous mass in the right lobe of the liver containing fat, calcification, and cystic and solid parts, all suggestive of a teratoma. A right hepatectomy and an omentectomy were performed. The pathology report showed a 27 cm mass composed of ectodermal, mesodermal and endodermal components with minimal atypia and foci of immature components suggestive of immature teratoma, which is the largest liver teratoma to be reported. The patient was discharged in good health. During 8 months of follow-up, a CT scan and α-fetoprotein levels were both normal, and the patient is still alive.     

Can treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs at the window of opportunity with tight control strategy lead to long-term remission and medications free remission in real-world clinical practice? A cohort study

Clinical Rheumatology - The aim of this retrospective study is to compare the results of starting rheumatoid arthritis (RA) treatment with tight control strategy in the window of opportunity and...     

Comparison of lisinopril versus atenolol for mild to moderate essential hypertension.

The antihypertensive effects and safety profiles of lisinopril (10 to 40 mg) and atenolol (50 to 100 mg) were compared in a randomized, double-blind, parallel group trial in 144 patients with essential hypertension. After 8 weeks of therapy, seated blood pressure (BP) decreased by 26/15 mm Hg with lisinopril and by 19/14 mm Hg with atenolol. Lisinopril produced a greater reduction (p less than 0.05) in sitting systolic BP than did atenolol. Standing BP decreased by 25/15 mm Hg with lisinopril and by 19/14 mm Hg with atenolol. No important changes in hematologic and biochemical profiles were seen with either drug. Eleven patients, 7 receiving lisinopril and 4 receiving atenolol, were withdrawn because of adverse experiences; another 3 patients defaulted during treatment, 1 in the lisinopril group and 2 in the atenolol group. Both drugs were well-tolerated and are therefore suitable for first-line therapy in essential hypertension.     

Factors associated with COVID-19 and its outcome in patients with rheumatoid arthritis

Objective

We assessed the factors associated with COVID-19, clinical manifestations, and a 30-day-prognosis of COVID-19 in a cohort of rheumatoid arthritis (RA) patients compared with the index population.

Methods

In a cross-sectional study, RA patients were followed in rheumatology clinics of Tabriz University of Medical Sciences, and a group of patients diagnosed with COVID-19 from index population were recruited. Outcomes of COVID-19 were assessed by the hospitalization rate and need to intensive care unit (ICU) and mortality. During a period of 12 weeks, 128 RA patients diagnosed with COVID-19, 760 RA control group, and 92 COVID-19 patients from index population were enrolled.

Results

Being female, obese, and diabetic, having pulmonary disease and chronic kidney disease (CKD), and treatment with prednisolone?>?5 mg/d and TNFα inhibitors (TNFis) were independent predictors of COVID-19 in RA patients. Dyspnea, anosmia, and taste loss were more common in RA patients compared with the index population. Admission in hospital, need to ICU care, and mortality occurred in 38, 11.9, and 8.6 percent of RA patients, respectively. Although hospitalization rate in RA patients was more than the index population, there were no significant differences in need to ICU care and mortality between the two groups.

Conclusions

Treatment with prednisolone and TNFis and having comorbidities including obesity, diabetes, pulmonary disease, and CKD increase the risk of COVID-19 in RA patients. Although some differences exist in the clinical manifestations of COVID-19 in RA patients and index population, prognosis of COVID-19 in RA patients is not any worse.