Hematoma of rectus sheath following subcutaneous enoxaparin injection

Anticoagulation drugs are frequently used to prevent deep vein thrombosis in high-risk patients. Subcutaneous low molecular weight heparin [LMWH] is increasingly used in both hospitalized patients and outpatient settings. This necessitates familiarity of both health care providers and patients with such treatment and vigilance on possible complications. Here we present a case of hematoma of rectus sheath that occurred following subcutaneous injection of enoxaparin and was successfully treated with conservative management

[Serum IgG4 levels in patients with ulcerative colitis, a predicting factor for primary sclerosing cholangitis?]

Primary sclerosing cholangitis [PSC] is a chronic cholestatic disease that results in segmental stenosis of the bile ducts, cholestasis and fibrosis. During the previous two decades, patients with steroid responsive PSC have been presented in a few case reports and studies. This study aims to evaluate and compare IgG4 levels in patients with ulcerative colitis [UC], with and without PSC. This cross-sectional study enrolled 116 patients with UC who referred to the Gastrointestinal Clinic of Imam Khomeini Hospital, Tehran, Iran. Patients with allergic diseases such as asthma and atopic dermatitis as well as those with autoimmune disorders such as vasculitis and systemic lupus erythmatosus were excluded. After signing an informed consent form, 5cc blood sample was taken for serum IgG4 evaluation. Patients with clinical or laboratory signs of PSC underwent Magnetic resonance cholangiopancreatography [MRCP] after which patients were divided into two groups [with and without PSC] according to the results of their MRCP findings. IgG levels more than 157 mg/dl were considered elevated. SPSS software package version 16 was used for data analysis. A significance level of 0.05 was considered statistically significant. There were 57[49.1%] male participants, of which 24 [20.7%] had evidence of PSC. Among these, 7 [29.1%] had elevated IgG4 titers. Of participants, 92 did not have PSC. From this group, 9 [9.7%] had elevated IgG4 levels. This difference was statistically significant [p =0.012]. The odds ratio was 3.9 [CI: 1.28-12.1] and the area under the curve for IgG4 in predicting PSC in the ROC curve was 0.65. There was a significant relationship between IgG4 titer and colitis extension in both groups. However there was no significant relationship regarding the severity of colitis [p=0.247]. It is necessary to evaluate IgG4 titers in all patients with PSC because of its treatable nature. Determining IgG4 levels in all UC patients can be a predicting factor for PSC. Thus additional cohort studies with larger numbers of participants are recommended.

[Distribution of HCV genotypes in hemodialytic patients of Guilan [the north province of Iran]]

Hepatitis C virus [HCV] infection has been identified as the major cause of chronic liver disease among patients on chronic haemodialysis [HD]. The aim of this study was to identify the HCV genotypes among chronic HD who were HCV positive in Guilan province in North of Iran. All the patients on HD from eleven Guilan HD centers were enrolled; their sera were screened for anti HCV antibodies by enzyme-linked-immunosorbent assay [ELISA] and polymerase chain reaction [PCR] and genotyping was performed in positive anti HCV cases. SPSS 14 was used for analysis and P<0.05 were considered statistically significant. Out of 514 enrolled patients, 61 [11.9%] were serologically HCV positive and 32[6.2%] had positive HCV RNA [CI 95%: [9.07-14.67]]. The most frequent genotypes were 1a and 3a with prevalence of 59.38% [CI95%: [42.36-76.4]] and 40.62% [CI 95%: [23.61-57.65]], respectively. There was no significant relation between virus genotypes and gender or age. An important finding was the high prevalence of genotype 3a [64.7%] in Rasht, the capital city of the province [P

Epidemiologic assessment of Leptospira serotypes in Caspian littoral

Leptospirosis is a widespread zoonosis in the world with more prevalence in tropical and subtropical regions. The disease is very common in flat area of Gilan, northern Iran, where the climate is humid and temperate and rice farming is main agricultural activity in rural areas. We performed this study in 2004 by taking blood samples from 465 hospitalized patients who were suspected of leptospirosis based on their clinical presentation, to find positive cases and analysis their signs, symptoms, and epidemiological data, and also to determine the most common clinical features of the disease in the area. All sera were examined by microscopic agglutination test. Renal failure was most common symptoms [4.5%]. Icterhaemorrhagia had highest titers in 57.0% of patients. In Gilan province, some of the farmers get leptospirosis each year near the end of spring and summer at the time of rice harvesting. Better recognition of the disease and diagnosing it at proper time can improve the quality of life and health state of the farmers

Seroprevalence of Hepatitis B and C among residents of Guilan Nursing Home

Viral hepatitis represents one of the most significant public health challenges. The institutionalization itself is an important factor influencing the risk and frequency of exposure and further spread of HBV and HCV infections. This study was carried out to determine the frequency of HBV and HCV serological markers in residents of Guilan nursing home. Demographic data and history of exposure to known risk factors were collected by interview and through medical records available at the nursing home; clinical information was obtained via examination. All residents were screened for markers of HBV and HCV. HBsAg or HCVAb positive cases were examined for HBeAg, HBcAb, and HCV-RNA, respectively; and complementary tests including AST, ALT, ALP, bilirubin, serum albumin, and prothrombin time [PT] were done. 383 residents of Guilan nursing home including 243 females [63.4%] with mean age of 58.4 +/- 21.9 years were investigated. The average duration of residency was 6.0 +/- 5.7 years. Nine cases [2.3%] including 6 males [4.2% of all males] were anti-HCVAb positive. Out of these 9 cases, 5 individuals were HCV-RNA positive. All of these 5 cases were male. The average duration of residency in HCV positive cases was 1.5 +/- 1.8 years in comparison with 6.1 +/- 5.8 years in negative cases. There was a significant reverse relationship between residency duration and HCV positivity in logistic regression. Residency in nursing home is not an important risk factor for viral hepatitis transmissions. However; we recommend precise and complete viral hepatitis screening on admission to nursing home and HBV vaccination for HBV negative cases