Seroprevalence of brucellosis and risk factors related to high risk occupational groups in kazeroon, south of Iran

Brucellosis is a major zoonosis worldwide. Many people for their professions are at higher risk of contracting the disease. To determine the seroprevalence of brucellosis and its risk factors in a group of high risk professions. In a cross-sectional study, all personnel or students of veterinary schools, slaughters and butchers working in the city were invited to participate [n=141]. A comparison group [n=44] randomly selected from patients who were selected at random from people attended our healthcare center for reasons other than the infectious diseases. 4 veterinarians, 15 veterinary assistants, 42 veterinarian students, 52 butchers, 17 slaughters, 8 slaughterhouse workers and 3 chefs made the first group and 14 storekeepers, 5 students of engineering, 11 clerks, 13 freelance workers, and 1 high school student made the comparison group. While the rate of consumption of most of the studied dairy products was almost similar in both groups, comparison group patients consumed more often milk [p<0.001] and cream [p<0.001] than the high risk group. 11 [7.8%; 95% CI: 3.4%-12.2%] cases from high risk group and none of the comparison group were found seropositive for Brucella. Profession is the main factor in seropositivity. Consumption of dairy products and raw milk is not associated with a higher risk of seropositivity

Ruptured sinus of valsalva aneurysm initially misdiagnosed as ventricular septal defect by echocardiography

Aneurysms of sinus of valsalva are rare cardiac lesions and most of them are in congenital origin. The malformation consists of a separation or lack of fusion between the media of the aorta and the annulus fibrosis of the aortic valve. The structure becomes aneurysmal and may rupture to form a fistula. We present a case of ruptured sinus of valasalva aneurysm in a 25-year-old man. The diagnosis was made by echocardiography and confirmed at operation

Prolonged atrio - ventricular block following scorpion bite: a case report

This report describes a 55-year-old woman in whom yellow scorpion sting resulted in the development of Mobitz type 1 and transient complete heart blocks unresponsive to atropine administration. It might be concluded that although autonomic involvement including parasympathetic overactivity is present in such cases, other factors such as toxic damage to the cardiac conduction system may play a role in the development of some of the cardiovascular manifestations of scorpion toxin

Neonatal tetanus in southern Iran: predisposing and prognostic factors

The predisposing and prognostic factors for neonatal tetanus [NNT] have not been adequately studied in southern Iran. The present study was undertaken in Fars Province to further clarify the status of neonatal tetanus in this region. The mortality rate was correlated with demographic and clinical findings in 112 cases of neonatal tetanus. In addition, the height and weight of NNT patients were compared to those of 112 age- and sex-matched normal neonates. Patients were predominantly males [82%] with a male to female ratio of 4.8:1. Although the clinical presentation and outcome of male and female patients were very similar, both groups had a significantly [p<0.05] lower birth weight compared to their control counterparts. None of the mothers had been immunized against tetanus and 92% had delivered at home under unsterile conditions. The mortality rate was 44% and strongly related to the age of the patients on admission. Conclusions: Male sex, low birth weight, and a lack of immunization of mother, all predispose the newborn to tetanus. The mortality rate was inversely proportional to the age of the newborn

Early acute respiratory failure due to severe tetanus: evidence for intrapulmonary shunting of blood

Early acute respiratory failure is a common presenting manifestation of severe tetanus, yet the underlying mechanism is not well understood. Our purpose was to clarify the issue by testing the contribution of various cardiopulmonary factors in the genesis of respiratory failure. We performed cardiac catheterization and pulmonary angiogram on 14 consecutive cases of severe tetanus with acute respiratory failure, Shunt fraction and alveolar-arterial oxygen difference were calculated in all patients after being ventilated with 100% oxygen for over 20 minutes. All patients had severe hypoxemia and hypocapnia at the time of presentation while receiving nasal oxygen. Cardiac catheterization and oximetric studies revealed normal mean pulmonary capillary wedge and left ventricular end diastolic pressures with no evidence of intracardiac shunting of blood. Pulmonary angiograms showed no evidence of pulmonary emboli or arteriovenous communication. Ventilation with 100% oxygen failed to correct hypoxemia. Calculated shunt fraction ranged from 27.3 to 38.1%. The alveolar-arterial oxygen difference was more than 450 mm Hg in all of the cases. Our results indicate that intrapulmonary shunting of blood is the underlying mechanism for the early acute respiratory failure seen in these patients

Contributing factors to the development of early acute respiratory failure and predisposiong factors to mortality in patients with severe tetanus

In this prospective study we compared the clinical data of 70 consecutive patients with severe tetanus and acute respiratory failure to those of 32 milder cases without acute respiratory failure. Also we investigated the predisposing factors to mortality among the former group. Severe hypoxemia [PaO2 <50 mmHg] was the initial presenting manifestation in all patients with acute respiratory failure. Along with severe hypoxia, 68 cases [97%] had hypocapnia [PaCO2 <36 mmHg]. Hypoxemia was unresponsive to ventilation with 100% oxygen. Alveolar-arterial oxygen difference ranged from 400 to 580 mmHg [497.37 +/- 54.36 mmHg]. Shunt calculation showed right-to-left shunting of blood ranging from 22.16 to 30.25% [27.89 +/- 1.70]. Convulsion [p<0.005], opisthotonos [p=0.01] and laryngospasm [p<0.001] were the major contributing factors to the development of early acute respiratory failure in cases with severe tetanus. Shorter incubation periods [p<0.05], sympathetic over activity [p<0.005] and sepsis [p<0.001] were the major predisposing factors to mortality in patients with acute respiratory failure. In conclusion, the early acute respiratory failure of severe tetanus is almost always of hypoxic and hypocapnic type. It is in part due to the generalized muscle spasms. In addition, intrapulmonary shunting of blood seems to be a major contributory factor in its genesis. Acute respiratory failure due to tetanus is a lethal disease especially if associated with a short incubation period and complicated with sepsis and or sympathetic overactivity

Mitral valve prolapse in Graves' disease

The prevalence of mitral valve prolapse was investigated by echocardiography in 191 Graves' disease patients from southern Iran. One hundred and fifty-eight asymptomatic healthy subjects were selected as a control group. Fifty-three patients [27.7%] with Graves' disease had mitral valve prolapse compared with 18 [11.39%] in the control group. The difference was statistically significant [p<0.05]

Determination of serum arginase in an animal model of liver necrosis

Arginase catalyzes the conversion of arginine to urea and ornithine in the liver of ureotelic animals. Higher activity of this enzyme has been detected in the sera of patients with hepatic diseases. Many difficulties inherent in current methods for arginase have hampered widespread use of this enzyme as a liver function test. We have developed a simple colorimetric method for determination of arginase. This method is based on the determination of remaining arginine, after its conversion, by reaction with p-nitrophenyl glyoxal [PNPG] at pH 9.0 to produce a color which absorbs maximally at 480 nm. The decrease in the absorbance in the presence of arginase is correlated with the enzyme activity. In this simple method color development as well as termination of enzyme activity is achieved by addition of a single reagent, i.e. PNPG, to the incubation mixture, thereby obviating the use of many chemicals ordinarily used in other methods for arginase. This method was used to measure the level of arginase in the sera of animals in which liver necrosis had been experimentally induced by oral administration of carbon tetrachloride, The results were compared with other enzyme that are currently used for liver function test. No arginase could be detected in the sera of healthy animals. Serum arginase elevated after 6 hours following administration of carbon tetrachloride, reached highest level after 24 hours and returned to normal at 72 hours. A similar pattern was observed for alkaline phosphatase and rhodanese, while the level of AST remained elevated for 48 hours and declined gradually thereafter. The Implication of these studies in human medicine are discussed