[Bacteriology of burned patients admitted to burn unit in northwest of Iran]

Background and Objectives: Infection is the major cause of death in burn injuries. There are several reasons which make burn victims susceptible to infection. Current study aimed to investigate the effects of different facts on bacteremia occurrence in burn patients

Materials and Methods: This descriptive analytic study conducted in year 2013 and 486 burn patients which admitted to educational-clinical centers of northwest Iran, were included. Patient's data including age, sex, lesion color, and percentage of burn were collected. Then we documented all interventions, blood tests and cultures and recorded colonies data

Results: In this study, 234 [48.1%] was male and 252 [51.9%] was female included with mean age 31.28 +/- 12.87 and bacteremia occurred in 51 patients. The most common wound infection agent was Klebsiella and the most common agent of bacteremia was Pseudomonas. In patients with extensive burn area, bacteremia and mortality occurred commonly [p=0.01, p=0.02]. According to relationship between mortality rate and bacteremia, in group of bacteremia, the mortality rate was more [P=0.03] and central venous catheter increased the tate of bacteremia [p=0.002]. The relationship between age and sex with bacteremia and mortality was not significant and in this research, the color of burn wound had no association with wound infection

Conclusions: Klebsiella is the most common wound infection agent and Pseudomonas is the most common agent of bacteremia. Mortality rate is in a direct relation with bacteremia and then by widening of burn area, respectively. Invasive interventions, increase the bacteremia susceptibility and mortality rate in burn wards

Thrombolytic therapy for cerebral vein thrombosis in antiphospholipid syndrome secondary to systemic lupus erythematosus

A 20-year-old woman was admitted to a Gynecology Hospital in her 6[th] month of pregnancy for high blood pressure and tonic-clonic seizure. Primary diagnosis was eclampsia, and for that reason she underwent cesarean section. She also had headache on frontal and parietal areas without nausea or vomiting. There was not a focal neurological sign. Rheumatology consultation was requested. Systemic lupus erythematosus and secondary antiphospholipid [APS] was confirmed. The patient had headache that continued several days after cesarean section, therefore, brain magnetic resonance imaging [MRI] and magnetic resonance venography [MRV] were performed, and cerebral vein thrombosis was documented. Distal segment of right lateral sinus and sigmoid sinus were not appeared in brain MRV. Abnormal hypersignal intensity of right lateral sinus/coronal T2 was detected. Thrombolytic therapy with 20 mg tissue plasminogen activator on right sigmoid and transverse sinus was performed by an interventional neurologist. After this procedure, the patient's headache healed and she was discharged in a good condition

Clinical manifestations of patients with novel H1N1 infecction hospitalized in infectious disease ward, Sina hospital, Tabriz, Iran

Novel H1N1 influenza virus is a unique type of an influenza virus which is built due to abrupt structural alterations. This virus created a pandemic disease. The manifestations and severity may be affected by environmental, cultural and economical condition. From October 2009 until December 2009, we had recruited 40 patients with H1N1 infection documented with RT-PCR. Their demographic features and presenting signs and symptoms as well as their associated laboratory data were recorded. During the study period, 40 patients were studied with a mean age of 36.8 +/- 13.0 years of whom 21 were admitted to ICU. Totally, 37.5% of patients had risk factors. Pneumonia was the most frequent lung involvement. The most prominent radiographic findings were bilateral ground glass opacity and ARDS [25%]. Cough and fever was the most prevalent presenting clinical symptoms. Unfortunately, 8 patients died. Independent risk factor of death was ICU admission and mechanical ventilation. Our findings were more or less the same as other centers, however, most of the studied subjects did not have an underlying risk factor. Except for pneumonia and ARDS, bilateral pulmonary thromboembolism were detected in patients all of whom discharged after complete recovery

Serum levels of TNF-alpha, TNF-alpha RI, TNF-alpha RII and IL-12 in treated Rheumatoid Arthritis patients

Rheumatoid arthritis [RA] is a chronic multisystem autoimmune disease common in all races and ethnics. Cytokines and cytokines receptors play an important role in RA pathogenesis and clinical presentation. To investigate the serum levels of TNF-alpha, TNF-alpha RI, TNF-alpha RII and IL-12 in RA patients and healthy control group. In this study 43 patients fulfilling the revised criteria of American College of Rheumatology [ACR] for RA and 13 healthy cases as a control group were selected for TNF-alpha, TNF-alpha RI, TNF-alpha RII and IL-12 serum level analysis. The patients' age was 42.2 +/- 22 and the age of healthy group was 40.1 +/- 19.2 years [p=0.1]. The patients had an active disease with at least six swollen and ten tender joints. Minimum ESR was 28 mm at first hours of the morning. Early morning stiffness in patients lasted longer than 45 minutes. Our study showed that IL-12 serum level of the patients [91.69 +/- 43.07 [rho]g/ml] and control [61.79 +/- 40.08 [rho]g/ml] group was significantly different [p<0.001]. The serum level of TNF-alpha RI was 2.36 +/- 0.77 ng/ml in the patient and 1.73 +/- 0.37 ng/ml in the control group [p<0.01]. TNF-alpha RII serum concentration in patients was 8.89 +/- 2.3 ng/ml, while that of control group was 7.06 +/- 1.30 ng/ml [p=0.03]. The serum level of TNF-alpha in patients was 32.90 +/- 19.27 [rho]g/ml and that of the control group was 24.27 +/- 8.28 [rho]g/ml [p=0.08] with no significant difference between the two. It is concluded that IL-12, TNF-alpha RI and TNF-alpha RII serum concentrations are more important and better predictive factors than TNF-alpha in RA course and in the active forms of the disease

Arterial atherosclerosis in patients with chronic kidney disease and its relationship with serum and tissue

We investigated the correlation between atherosclerosis and tissue and serum levels of endothelin-1 in patients with chronic kidney disease [CKD]. Arterial samples were obtained from 35 patients with CKD during arteriovenous fistula placement. Thirty-one patients with cardiovascular disease who underwent coronary artery bypass graft [CABG] were selected as the atherosclerotic group, and a piece of their aorta punched during CABG was obtained. Also, a small piece of the renal artery was dissected during donation in 24 kidney donors [control group]. Tissue endothelin-1 level was measured and atherosclerosis grading was determined by pathologic examination. Serum levels of endothelin-1 were also measured in the three groups. The mean tissue endothelin-1 levels were 10.73 +/- 7.57 pg/ mL, 12.16 +/- 3.95 pg/mL, and 0.93 +/- 1.06 pg/mL in the patients with CKD, those with CABG, and donors, respectively [P < .001]. The mean serum endothelin-1 level was 25.23 +/- 15.15 pg/mL in the patients with CKD, 21.13 +/- 17.22 pg/mL in the patients with CABG, and 2.66 +/- 1.51 pg/mL in the donors [P < .001]. Atherosclerosis grades correlated with tissue endothelin-1 level [r = 0.823, P < .001] and serum endothelin-1 level [r = 0.608, P < .001] in the patients with CKD. Multiple regression analysis showed tissue endothelin-1 level as the main predicting factor of atherosclerosis [P < .001]. Tissue endothelin-1 concentration is more important than serum endothelin-1 or lipids levels in prediction of atherosclerosis. Thus, blockade of tissue endothelin-1 receptors with its antagonists may prevent atherosclerosis progression

Recurrent acute kidney failure due to mcardle disease

We present an adolescent with McArdle disease and recurrent acute kidney failure due to rhabdomyolysis. The patient was admitted with acute kidney failure for 3 times and due to a history of proximal weakness, fatigue, and muscular cramps after physical activities a glycogen-storage disease was suspected. Serum creatine phosphokinase and urine myoglobin were found to be elevated. McArdle disease was diagnosed based on pathologic examination of muscle tissue specimen. Patients presenting with rhabdomyolysis following strenuous exercise should be evaluated for McArdle disease