Adult-onset familial Mediterranean fever in northwestern Iran; clinical feature and treatment outcome

Familial Mediterranean fever [FMF] is an autosomal recessive disorder characterized by sporadic, paroxysmal attacks of fever and serosal inflammation. Although the disease usually begins before the age of 20 years, we aimed to evaluate the demography, clinical features and treatment outcome of familial Mediterranean fever in Iranian adult patients above 20 years old. In this cross-sectional study, adult patients [first attack at the age of > 20 years] with a diagnosis of FMF who referred to the gastroenterology and rheumatology clinics of Ardebil University of Medical Science [situated in north west of Iran] over the period of 2004-2009 were enrolled. FMF diagnosis was based on clinical criteria. Forty four FMF patients [30 male and 14 female] with the mean [ +/- Standard Deviation [SD]] age of first attack of 29 +/- 7.8 years were enrolled. Abdominal pain [95.5%] and fever [91%] were the most common clinical findings. All of the patients had satisfactorily responded to therapy. Response was complete in 76.7% and partial in 23.3% of the patients. There was no clinical or laboratory evidence of amloidosis at the time of diagnosis or during follow-up. Our findings demonstrated that adult-onset FMF in Iran has different characteristics [more common in males, lesser prevalence of arthritis and erysipelas-like erythema, less delay in diagnosis] and treatment outcome [favorable response even to low-dose colchicines] in comparison with the previous data on early onset patients

Effect of metoclopramide on nosocomial pneumonia in patients with nasogastric feeding in the intensive care unit

This study in the Islamic Republic of Iran aimed to determine whether metoclopramide can prevent nosocomial pneumonia in the intensive care unit [ICU]. Of 220 patients admitted to the surgical ICU who had a nasogastric tube for more than 24 hours, 68 case patients received oral metoclopramide [10 mg every 8 hours] and 152 control patients did not. Similar proportions of cases and controls developed nosocomial pneumonia [33.8% versus 33.6%]. Endotracheal intubation was a risk factor for nosocomial pneumonia [odds ratio 7.70]. There were no significant differences between groups in mortality rate or time of onset of nosocomial pneumonia. Metoclopramide appears to have no effect on the development of nosocomial pneumonia with nasogastric feeding

Trauma mortality in six university hospitals: Tehran, Iran

Trauma is the most common cause of mortality in the first four decades of life. In our country, cardiovascular diseases and trauma are leading causes of mortality, respectively. By gathering information on trauma mortalities, we can learn more about causes, and that knowledge can lead to prevention. This is a prospective descriptive study in Tehran during 12 months period [Sep 1999- Sep 2000]. Two hundred and forty five trauma deaths in six hospitals were evaluated. The data was collected through a questionnaire, designed in Sina Trauma and Surgery Research Center [STSRC] used for the study. The questionnaires were completed by trained physicians visiting trauma patients in emergency room and wards round the clock. Data obtained included patient demographics, level of prehospital care, medical and operative procedures performed in emergency rooms [ER] and wards [according to ICD-10 coding], Glasgow Coma Scale [GCS] and vital signs at time of presentation to emergency rooms, Injury Severity Score [ISS], length of hospital stay and outcome of patients. Twenty and forty five [3%] of 8000 trauma patients was died. Mean age was 40.7 [ +/- 23.5] years old and 208 [84.9%] patients were male. The highest mortality rate was seen in the age group of 25 to 30 years. Road Traffic Accident was the main cause of death followed by falling with 174[71%] and 41[16.85], respectively. Among victims of road traffic accident, pedestrians and motorcyclists were prominent with 119 and 28 cases respectively. The majority of cases were dead due to head injuries [69%] and abdominal trauma was the second cause with 19 [7.8%] cases. Based on our findings the mechanism of injury have the positive effect on trauma outcome. Traffic accidents and assault is preventable and must be attended

brucella costochondritis

A 22-years-old presented with sever man pain in Costochondral region and mild fever, anorexia, sweating and weight-loss. He had history of consumption of non-pasteurized cheese. In physical examination patient was ill and diaphoretic, temperature 37.8°C and severe tenderness in third right Costa chondral junction. STA for Brucella was positive [1/320]. Patient treated with rifampin and doxycyclin. Constitutional symptoms subsided after 10 days but costochondral pain in 1 month. In endemic area patients with costochondritis also should evaluated for brucellosis

Incidences of nosocomial pneumonia in patients above 15 years in intensive care units of university hospital in Semnan

Nosocomial Pneumonia [NP] is an infection of lung parenchyma that could happen at least 48 hours after admission in hospital. After urinary tract infection, it is the second most common nosocomial infection and is most common in Intensive Care Units [ICU]. Incidence of NP in ICU is about 10-20%. 402 patients evaluated in Emdad and Fatemieh hospitals. Variables were age, gender, depressed level of consciousness, mechanical ventilation, nasogastric tube, thoraco-abdominal surgery and medical or surgical ICU patients visited daily. Criteria of NP were fever after 48 hours, leukocytosis, increase in pulmonary secretion and chest X-ray findings. Logistic Regression was used for analysis data. 9.2% [CI 95%; 6.4-12.0%] of patients developed NP. In patients with mechanical ventilation and depressed level of consciousness, incidence was 7.6 times and 2.7 times more than others, respectively. There was no relationship between NP and other variables. Mechanical ventilation and unconsciousness are important risk factors for NP. Thus, these patients require more and better cares. Furthermore, intervention should be avoided if patients require mechanical ventilation meticulous aseptic care for respirator equipments and suctioning is needed