Mucormycosis after scorpion sting: case report

Mucor is a fungus, which give rise to opportunistic infection in immunocompromised patients. We described a 55‐year‐old immunocompetent woman with cutaneous mucormycosis after scorpion sting. Mucormycosis may happen in patients with intact immunity and is not allocated only to patients with immune deficiency.     

Contrast-enhanced intravascular ultrasound: combining morphology with activity-based assessment of plaque vulnerability

Acute coronary syndromes are the result of coronary plaque rupture in the majority of cases. Available diagnostic techniques that focus on the early detection of plaques that are prone to rupture are still limited. Increased neovascularization in the vasa vasorum of the atherosclerotic plaque has been identified recently as a common feature of inflammation and plaque vulnerability. Microbubbles, which have been used for ultrasound imaging, can be used to trace neovascularization. We present recent advances in contrast agents and contrast-enhanced intravascular ultrasound that may be used for the detection of vasa vasorum, including fundamental and harmonic contrast imaging. Identification of vasa vasorum proliferation in atherosclerotic plaques presents important clinical implications; in particular it could provide a means to detect vulnerability in vivo, thereby guiding targeted treatments.     

Assessment of the longitudinal and circumferential left ventricular function at rest and during exercise in healthy elderly individuals by tissue-Doppler echocardiography: relationship with heart rate

Tissue-Doppler echocardiography (TDE) has been introduced to quantify stress echocardiography by means of assessing the left ventricular (LV) segmental myocardial velocities and excursion. The interaction between LV long- and short-axis function during physical exercise has not been elucidated completely. The aim of the present study was to investigate long- and short-axis LV function, as assessed by myocardial velocities and excursions at rest and during exercise and its possible relationship with heart rate in healthy elderly individuals by TDE. Twenty-seven individuals underwent an exercise test in the supine position on a bicycle ergometer. The initial workload was 30 Watts, followed by 20-Watt increments every third minute. Standard echocardiographic images with super-imposed colour TDE were digitized at the end of each step. The following variables were studied in the LV long- and short-axis: myocardial peak systolic velocity (PSV) and excursion, isovolumic contraction and relaxation times, peak velocity at early diastole (E'-wave) and peak velocity at late diastole (A'-wave) and the E'/A' ratio. Increments in myocardial peak systolic velocity and excursion in the LV long-axis were more pronounced during low workloads. The increase in those variables in the short-axis occurred mainly at higher exercise loads. The improvement in LV long- and short-axis functions was closely related to the increase in the heart rate. Shortening of the isovolumic contraction and relaxation times occurred only at the initial stages of exercise. An increase in the long-axis E'/A' ratio occurred during exercise, whereas this ratio was unchanged in the short-axis. In conclusion, during exercise, the LV long- and short-axis functions behave differently, and increases in LV long- and short-axis functions are related to changes in heart rate. Therefore, in the interpretation of echocardiographic findings during exercise stress echocardiography, these facts have to be taken into account.     

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

AIM： To evaluate portal hypertension parameters in liver cirrhosis patients with and without esophageal varices （EV）. METHODS： A cohort of patients with biopsy confirmed liver cirrhosis was investigated endoscopically and with color Doppler ultrasonography as a possible noninvasive predictive tool. The relationship between portal hemodynamics and the presence and size of EV was evaluated using uni- and multivariate approaches. RESULTS： Eighty five consecutive cirrhotic patients （43 men and 42 women） were enrolled. Mean age （± SD） was 47.5 （± 15.9）. Portal vein diameter （13.88 ± 2.42 vs 12.00 ± 1.69, P 〈 0.0005） and liver vascular index （8.31 ± 2.72 vs 17.8 ± 6.28, P 〈 0.0005） were found to be significantly higher in patients with EV irrespective of size and in patients with large varices （14.54 ± 1.48 vs 13.24 ± 2.55, P 〈 0.05 and 6.45 ± 2.78 v$10.96 ± 5.05, P 〈 0.0005, respectively）, while portal vein flow velocity （13.25 ± 3.66 vs 20.25 ± 5.05, P 〈 0.0005）, congestion index （CI） （0.11 ± 0.03 vs 0.06 ± 0.03, P 〈 0.0005）, portal hypertensive index （2.62 ± 0.79 vs 1.33 ± 0.53, P 〈 0.0005）, and hepatic （0.73 ± 0.07 vs 0.66 ± 0.07, P 〈 0.001） and splenic artery resistance index （R/） （0.73 ± 0.06 vs 0.62 ± 0.08, P 〈 0.0005） were significantly lower. A logistic regression model confirmed spleen size （P = 0.002, AUC 0.72） and portal hypertensive index （P = 0.040, AUC 0.79） as independent predictors for the occurrence of large esophageal varices （LEV）. CONCLUSION： Our data suggest two independent situations for beginning endoscopic evaluation of compensated cirrhotic patients： Portal hypertensive index 〉 2.08 and spleen size 〉 15.05 cm. These factors may help identifying patients with a low probability of LEV who may not need upper gastrointestinal endoscopy.     

Intrinsic Frequency and the Single Wave Biopsy: Implications for Insulin Resistance

Insulin resistance is the hallmark of classical type II diabetes. In addition, insulin resistance plays a central role in metabolic syndrome, which astonishingly affects 1 out of 3 adults in North America. The insulin resistance state can precede the manifestation of diabetes and hypertension by years. Insulin resistance is correlated with a low-grade inflammatory condition, thought to be induced by obesity as well as other conditions. Currently, the methods to measure and monitor insulin resistance, such as the homeostatic model assessment and the euglycemic insulin clamp, can be impractical, expensive, and invasive. Abundant evidence exists that relates increased pulse pressure, pulse wave velocity (PWV), and vascular dysfunction with insulin resistance. We introduce a potential method of assessing insulin resistance that relies on a novel signal-processing algorithm, the intrinsic frequency method (IFM). The method requires a single pulse pressure wave, thus the term “ wave biopsy.”     

Clinical features of epilepsy at 2 referral hospitals in Northern Iran

Objective:

To investigate the demographic and clinical characteristics of epilepsy in 2 referral hospitals in northern Iran.

Methods:

In this cross-sectional study, we evaluated 300 patients with the confirmed diagnosis of epilepsy referred to the Neurology clinics of 22-Bahman, and 17-Shahrivar Hospitals, Mashad, Iran, from April 2011 to December 2012. We collected and analyzed demographic and disease information.

Results:

The mean age of patients was 31.5 ± 15.3 years. The diagnosis of disease had been made approximately 10 months after the onset of symptoms, and the treatment gap was 28%. The most widely used anticonvulsants were sodium valproate, carbamazepine, and phenobarbital. Generalized seizure was seen in 78%, partial seizure in 22%, and a combination of them in 11% of patients. Tonic-colonic seizure (72%) was the most common type of generalized epilepsy, and secondarily generalized seizure was the most frequent type of partial epilepsy.

Conclusion:

The epidemiological features of epilepsy in our region with regard to age and gender are the same as other parts of the world. The generalized type is the most common form of epilepsy, with tonic-colonic seizures being the most frequent type in our area.Epilepsy is a common and chronic neurological disorder that affects individuals of all ages and is characterized by recurrent (2 or more) unprovoked epileptic seizures.1 Seizure is an episode of involuntary movement, which may involve a part of the body or the entire body (generalized) and may be accompanied by loss of consciousness and control of bowel or bladder function. Seizure episodes are caused by abnormal electrical discharge in a group of brain cells. The age-adjusted prevalence and incidence of epilepsy in the general population are approximately 5 per 1000 person-years, and 50 per 100,000 person-years.2 The lifetime prevalence rate of epilepsy in developed countries is 3.5 to 10.7 per 1,000 person-years.3,4 Epilepsy affects 50 million people worldwide.5 The prevalence and incidence of epilepsy and consequently its burden is higher in developing countries than in developed countries.6 Approximately 80% of patients with epilepsy live in developing countries and so 80% of the disease burden is attributed to developing countries.6 Detailed classification of seizures and epilepsy is essential to understanding its nature, with a rational plan of investigation and decision making regarding the timing and duration of treatment and choice of antiepileptic drug. As our country is a developing country, better understanding of epilepsy features could provide better management and control of disease, and so decrease the burden of it. As the epidemiological and clinical characteristics of epilepsy are not yet completely understood in Iran, this study aimed to investigate the demographic and clinical features of epilepsy in 2 referral hospitals in our region.     

Collagenous matrix supported by a 3D-printed scaffold for osteogenic differentiation of dental pulp cells

Objective

A systematic characterization of hybrid scaffolds, fabricated based on combinatorial additive manufacturing technique and freeze-drying method, is presented as a new platform for osteoblastic differentiation of dental pulp cells (DPCs).