54-year-old woman with chronic cough and an endobronchial mass

We report a case of a 54-year old female who presented with chronic cough. Computerized tomography [CT] scan of the chest was not remarkable. She underwent empirical treatment for common causes of chronic cough for months to no avail, after which flexible bronchoscopy revealed right lower lobe endobronchial mucoepidermoid carcinoma. Surgical resection resulted in complete resolution of the cough. In patients with refractory cough who do not respond to conventional medical therapy, examination of endobronchial tree by bronchoscopy is strongly recommended

65-year-old woman with granular cell tumor of the lung

We present a case of a 65 year-old female who admitted with fever and a small in filtrate on the chest x-ray. CT-scan showed presence of a well-circumscribed solitary mass. She underwent surgical resection which showed presence of a granular cell tumor. Clinical and pathological features of granular cell tumor will be described in this report

Molecular characterization of Fasciola hepatica isolates by RAPD-PCR and ribosomal ITS1 sequencing

Understanding genetic structure and status of genetic variation of the Fasciola hepatica populations has important implications for epidemiology and effective control of fasciolosis. The aim of the present study was to genetically characterize F. hepatica isolates from different hosts, using sequence analysis of ribosomal ITS1 and RAPD-PCR. Fifty three adult F. hepaticas were isolated from naturally infected cattle, sheep, buffalo and goat from two regions in Iran. Genomic DNA was extracted from 70% ethanol preserved flukes. RAPD-PCR with a set of arbitrary primers [UBC90 and R151] was used to estimate genetic variation within the species. Ribosomal ITS1 region of the isolates was amplified, using primers specifically designed for this study. Ten samples [4 sheep, 2 cattle, 3 buffaloes and one goat isolate] were sequenced at ITS1 and analyzed, using DNASIS and ClustalW softwares. F. hepatica ITS1 region was amplified successfully for all samples and a band of 470 bp was shown in all cases. Different isolates did not show any significant genetic variations in rDNA-ITS1 as all the sequences showed to be 100% identical. RAPD results of 52 samples, in particular those with UBC90, showed different patterns within F. hepatica isolates of each host. RAPD data for this primer showed three different patterns for each of sheep and cattle isolates and two patterns in buffalo isolates. All the 14 cattle isolates come up with an identical pattern, using primer R151. The study showed the variability of F. hepatica isolates in Iran, using RAPD markers. No intraspecies variation was seen in the Iranian F. hepatica isolates at ITS1 rRNA gene, indicating highly conserved nature of this region

Pseudo-outbreak of stenotrophomonas maltophilia and acinetobacter baumannii by a contaminated bronchoscope in an intensive care unit

Stenotrophomonas maltophilia and Acinetobacter baumannii are serious offending agents of nosocomial pneumonia and of serious morbidity and mortality in intensive care units [ICU]. We report an unexpected sudden surge in cases of pneumonias caused by the above organisms in an intensive care unit of a community hospital in a span of two months. The source was traced back to a contaminated bronchoscope. The records from the patients with diagnosis of pneumonia with the above organisms were retrospectively reviewed. Specimens from the ports and channels of the bronchoscope that was suspected to be the cause were taken and microbiologically analyzed. Two patients with Acinetobacter and four patients with Stenotrophomonas positive bronchoalveolar lavage [BAL] fluid cultures were identified within a 2-month period in one of our two intensive care units. All of the patients were mechanically ventilated, and had clinical features of pneumonia. Their bronchoscopies were performed and their BALs were obtained by a scope with an identical serial number. The microbiologic evaluation of samples taken from the suspected scope revealed that it was improperly decontaminated between procedures. After implementation of strict and revised decontamination protocol, there were no further cases of pneumonia caused by the above organisms in a span of several months in mechanically ventilated patients. Inadequate disinfection of bronchoscopes and cross contamination between patients could be a potential cause of ventilator-associated pneumonia. Strict implementation of infection prevention guidelines in bronchoscopies of mechanically ventilated patients could prevent cases of ventilator-associated pneumonias by nosocomial agents including S. maltophilia and A. baumannii

In vitro antiamoebic activity of Iranian Allium sativum in comparison with metronidazole against entamoeba histolytica

Amoebiasis is due to infection with the protozoan parasite Entamoeba hislolytica. The patients infected with E. histolytica must be treated right after definite diagnosis and no need to treat infected individuals with E. dispar isolates. Metronidazole is used as a drug of choice against amoebiasis. However, like a lot of other chemical agents, this drug has its own side effects. This prompted us to carry out, an in vitro research into antiamoebic effect of Iranian Allion, sativum [garlic], which has been used for centuries, as an herbal medicine, without harmful side effects. Hydro-alcoholic, hexanic extracts and essential oil of 100 gram of crushed A. sativum was isolated and the minimal inhibitory concentration [MIC] of the extracts and essential oil in comparison with metronidazole were obtained on trophozoite of E. histolytica, HM-1: IMSS strain in TYI-S-33 medium. The MIC for A. sativum hydroalcoholic. hexanic extracts and essential oil after 24 hours was 60mg mL[-1], 4mg mL[-1] and 0.4mg mL[-1], respectively. After 48 hours the MIC for A. sativum hexanic extract and essential oil was 3mg mL[-1] and 0.3mg mL[-1], respectively. MIC for metronidazole was obtained 2 micro g mL[-1] and 1.5 micro g mL[-1] after 24 hours and 48 hours, in that order. Iranian A. sativum is effective on the trophozoites of E. histolytica species and the essential oil exhibited the greatest antiamoebic activity, at the lowest MIC

alternative method for perioperative estimation of pulmonary artery systolic pressure by echocardiography

In the perioperative setting, pulmonary hypertension may be due to ischemic, left-sided valvular regurgitation and stenosis, residual shunt, pulmonary emboli or pericardial effusion. We purposed this study to determine whether tricuspid annular plane systolic excursion [TAPSE] and isovolumic relaxation time [IVRT] and S-wave velocity obtained by tissue Doppler imaging [TDI] could be used as an index of pulmonary systolic pressure in perioperative setting. Simultaneously, tricuspid annular plane systolic excursion and TDI by Echocardiography and right heart catheterization by Swan-Ganz catheter were performed in 55 patients [mean age 46 years,30 were male] with left -sided valvular disease [n=25], ischemic heart disease [n= 15] and adult-congenital heart disease [n= 10]. The TAPSE index S wave velocity from tricuspid annulus were measured by TDI. We also measured pulmonary artery systolic pressure [PASP] by right cardiac catheterization. In patients with moderate and severe pulmonary hypertension [PASP>45mmHg] the TAPSE value was [15.5 +/- 2.3mm]with sensivity of 90%and specifity of 80%. S wave velocity <11cm/s with sensivity of 90% and specifity of 86% and IVRT >79ms with sensivity of 93% and specifity of 95% [p<0.001]. Some factors such as underlying diseases [left-sided valvular disease, ischemic heart disease [IHD], congenital heart disease] had no effect on this correlation. We conclude that the evaluation of TAPSE index and IVRT and S-wave velocity by echocardiography provides a simple, rapid method for estimating of systolic pulmonary pressure in perioperative setting

[Intravitreal triamcinolone acetonide in chronic refractory uveitis]

To evaluate the effect of intravitreal triamcinolone acetonide injection for management of chronic refractory uveitis in terms of inflammation, visual acuity and macular thickness. This interventional case series was conducted on uveitic eyes with no remission despite proper administration of periocular and/or systemic steroids. After systemic and rheumatologic evaluations and confirmation of non-infectious nature of uveitis, 18 eyes of 10 patients underwent intravitreal injection of 4 mg triamcinolone acetonide. Changes in intraocular inflammation, bestcorrected visual acuity [BCVA], intraocular pressure [IOP] and macular thickness on optical coherence tomography were assessed during six months of follow-up. Mean BCVA increased from a baseline value of 0.81 +/- 0.29 to 0.35 +/- 0.33 LogMAR one week and to 0.17 +/- 0.07 LogMAR one month after the injection, respectively [P<0.001]. It decreased thereafter to 0.46 +/- 0.3 LogMAR at the sixth month visit, but was still significantly greater than the baseline value [P<0.001]. Mean IOP reached its maximum level one month post-injection with an increase of 7.36 +/- 0.48 mmHg compared to the baseline value, however only two eyes had IOP>22 mmHg which were successfully controlled using topical IOP-lowering medication. Mean central macular thickness decreased from 339.8 +/- 24.1 microm to its minimum value [197.18 +/- 12.7 microm] one month after the injection [P<0.001] and then increased to 203.57 +/- 9.06 microm at sixth month visit, still less than the baseline value [P< 0.001]. Intravitreal injection of triamcinolone acetonide in chronic refractory uveitis improves visual acuity and decreases central macular thickness which is sustained for at least six months. The only noticeable complication, transient IOP elevation can be controlled with topical medications