Seroepidemiological study of visceral leishmaniasis in Booyerahmad district, south-west Islamic Republic of Iran

Visceral leishmaniasis [VL] is endemic in parts of Islamic Republic of Iran. A cross-sectional seroprevalence study was carried out in children in Booyerahmad district in the south-west of the country. Serum samples were taken from 1628 children up to 10 years old from different areas in Booyerahmad in 2005-06. Anti-Leishmania antibody was detected in 50 out of 1628 children [3.1%] by direct agglutination test [antibody titre > 1:3200]. There was no significant difference in seropositivity between the sexes [2.8% males and 3.3% females]. The highest rate of infection [5.2%] was in the age group 10 years. Further studies are needed to explore the reservoirs and vectors of the disease in this region

[Prevalence of hepatitis B antibodies in health-care workers in Yasuj Hospitals]

Hepatitis B is a common infection in the world and one of the main health problems in our country. Over 350 million people are infected with Hepatitis B virus in the world and are chronic carriers of this infection. Health care workers are at risk of infection with blood born viruses including hepatitis B [HBV]. This study was conducted to find out the rate of anti-HBs antibodies among the health-care workers [HCW] in Yasuj hospitals, Southwest of Iran. This is a cross sectional descriptive study in which 212 staff was randomly selected from different wards of the hospitals in Yasuj. Blood samples were taken from each individual and tested for hepatitis B surface antibody [anti-HBs] by ELISA. Those who had anti-HBs titer > 10 IU/ml were considered as positive. Collected data were analyzed by SPSS software using descriptive data analysis and chi-square test. 61.3% of the subjects were female and 38.7% were male. 93.9% of the subjects had a history of one to three doses of hepatitis B vaccination. Results of this study showed that 185 [87.3%] of the staff have anti hepatitis B antibodies [Anti-HBs]. Among the staff that was negative for anti-HBs antibody, 12 had a history of hepatitis B vaccination [at least one dose]. Female employees were more positive than males [93% vs. 78%] and this difference was statistically significant [p<0.05]. Moreover, a positive correlation was found between the titer of antibody and sex where females had a higher titer of antibody in comparison with males [p<0.05]. No correlation was found between the workplace of HCW and positive anti-HBS. Result of this study indicates that more than 85 percent of the health-care workers in Yasuj have reasonable immunity against hepatitis B infection. A small proportion of HCWs had no immunity against HBV. The second course of hepatitis B vaccine should be delivered to those who had no immunity against hepatitis B despite their receiving the first course of vaccination

[Case series report of renal cell carcinoma with inferior vena cava involvement [surgery techniques and results in 8 patients]

Renal cell carcinoma can be presented with extension of thrombosis to renal vein and inferior vena cava. Management of these patients consists of radical nephrectomy and thrombectomy. In this study we reviewed approach to these patients. This is a case series report. During 1379 to 1384, 148 patients diagnosed with renal cell carcinoma [RCC] limited to Gerota's fascia [stage T3 or less] were admitted to Hasheminejad hospital. Fourteen patients had inferior vena cava [IVC] involvement. Radical nephrectomy as well as thrombectomy was performed in 8 patients. This investigation is done on these 8 patients. Patients' average age was 51.4 years. Six patients were male [75%] and 2 female [25%]. The most common symptoms were flank pain [75%], gross hematuria [62.5%] and structural symptoms [50%]. All patients had tumors limited to Gerota's fascia without any distant metastasis. Infrahepatic involvement of IVC was seen in 6 patients and in 2 patients thrombosis extended above the hepatic vein [infrahepatic]. No perioperative mortality was seen. Postoperative complications were atelectasia in 2 patients and deep vein thrombosis in one which was treated with conservative management. By skillful surgical approach in patients with RCC and IVC involvement, thrombosis can be completely excised without increasing the rate of complications and long term survival could be expected

Risk factors and laboratory diagnostics for post renal transplant tuberculosis: a case-controlled, country-wide study on definitive cases

Tuberculosis [TB] is a common cause of morbidity and mortality in renal transplant recipients. It is usually misdiagnosed because of lack of medical awareness and its infrequency in renal transplant recipients. 44 cases [0.3%] with post-transplant TB out of 12820 patients who had renal transplants performed between 1984 to 2003 were found from the hospital records of 12 major kidney transplantation centers in Iran. These cases were compared with 184 healthy transplant subjects whose transplants were performed by the same surgical team as the controls. The mean age of cases and controls was 37.7 [13-63] and 35.6 [8-67] years [p=0.3], respectively. The mean duration of pre-transplantation hemodialysis was 30.3 [3-168] months in cases and 18.2[1-180] months in controls [p=0.03]. A past history of tuberculosis was detected in 2 cases and 1 control [p=0.3]. The mean doses of initial and maintenance immunosuppressive drugs in cases and controls were not significantly different. A total of 25 cases [56.8%] and 60[32.6%] controls had rejection prior to diagnosis of TB [p=0.004; OR=2.7, CI95%: 1. 3-5.6]. To our knowledge, this is the first study that demonstrated increasing risk of post-transplant TB by extending the duration of pre-transplant hemodialysis and the number of post-transplant rejection episodes. Further study is needed to clarify our new findings specifically in respect of different immunosuppressive regimens

results of grade IV cystocele repair using mesh

To evaluate the results of grade IV cystocele repair by 4-corner bladder and bladder neck suspension technique, using prolene mesh. Thirty-one women with a median age of 61 years and severe anterior vaginal wall prolapse [grade IV cystocele] were treated by 4-corner bladder and bladder neck suspension technique, using prolene mesh. Of these, 3 had associated uterine prolapse, rectocele, and enterocele, one had rectocele and enterocele, and 18 had rectocele only. In these cases, pelvic floor defects were also repaired simultaneously and in 3, vaginal hysterectomy was done. Twelve patients had a previous failed cystocele repair. In a 32-month follow-up, the patients were evaluated with vaginal examination and upright cystography. Urinary continence during increased intraabdominal pressure was also assessed, based on subjective symptoms. None of the patients had cystocele recurrence. Urinary continence during increased intra-abdominal pressure was seen in all of the patients. Intraoperative rectal or bladder injury did not occur. Transfusion was not required in any of the cases. Early complications [6 to 8 weeks postoperatively] included irritative urinary symptom in 17 patients, of whom, 8 had documented urinary tract infection that were treated successfully. Late complications were spotting in 3 cases [two were treated with topical estrogen and vaginal mucosal repair was done in one], dyspareunia in 4 sexually active patients, changes in urination pattern in 28 [improved significantly with behavioral therapy], long-term urge incontinence [>8 weeks] in 5 [medical treatment was successful in these patients], and prolonged intermittent catheterization in 1. Pelvic abscess and migration of mesh were not observed. According to our findings, using mesh in patients with grade IV cystocele, who had a previous failed surgery or weakness in supportive pelvic tissue, is an appropriate treatment modality