Fatal case of Plasmodium vivax malaria in a splenectomized patient

Malaria is a major problem in tropical and sub-tropical countries, with high morbidity and mortality. Splenectomy makes patients more susceptible to serious bacterial and parasitic infections. We report for the first time in Iran a fatal case of Plasmodium vivax malaria, confirmed by microscopic and molecular [Semi-nested multiplex PCR] tests in a patient who had undergone splenectomy due to hemolytic anemia

Epidemiological aspects of visceral leishmaniasis in Baft district, Kerman province, southeast of Iran

Visceral leishmaniasis [kala-azar] is an endemic disease in some areas of Iran. A cross-sectional study was conducted for sero-epidemiological survey of visceral leishmaniasis [VL] in Baft district from Kerman Province, southeast of Iran. Blood samples were collected from children up to 12 years old and 10% of adult population from Baft villages with a multi-stage randomized cluster sampling. In addition, blood samples were collected from 30 domestic dogs from the same areas. All the collected blood samples were tested by direct agglutination test [DAT] for the detection of anti-Leishmania antibodies in both human and dog using the cut-off value of >/= 1:3200 and >/= 1:320, respectively. Parasitological, molecular, and pathological were performed on infected dogs. Chi-square and Fisher exact tests were used to compare sero-prevalence values. From 1476 collected human serum samples, 23 [1.55%] showed anti-Leishmania antibodies at titers of 1:800 and 1:1600 whereas 14 [0.95%] showed anti-Leishmania infantum antibodies at titers of >/= 1:3200. No statistically significant difference was found between male [1.18%] and female [0.69%] sero-prevalence [P=0.330]. Children of 5-8 years showed the highest sero-prevalence rate [3.22%]. Seven out of 30 domestic dogs [23%] showed anti-Leishmania antibodies at titers >/= 1:320. Leishmania infantum was identified in five infected dogs by nested -PCR assay. It seems that visceral leishmaniasis is being endemic in southern villages of Baft district, southeast of Iran

[Tracheal intubation without muscle relaxants in patients under coronary artery bypass surgery]

Although the conventional technique in coronary artery bypass surgery [CABG] consists of using long-acting opioids and muscle relaxants, but in some situation usage of long acting drugs may be hazardous. Administration of remifentanil followed by propofol provides adequate conditions for tracheal intubation without muscle relaxants. This study was performed to evaluate intra thracheal intubation without muscle relaxants in CABG. This double - blind clinical experimental study was done in the cardiosurgery department of Imam Reza Hospital in the year 2004. Intubation conditions and hemodynamic and ST changes in premedicated patients, candidate for CABG surgery was compared. 90 patients with New York heart association class I-II were assigned to one of three groups [n=30]. After prehydration with ringer solution, sufentanil l micro/kg or remifentanil 2 or 4 micro /kg was injected followed by 1.5 mg/kg propofol. Ninety seconds after administration of the propofol, laryngoscopy and intubation were attempted. Intubation conditions were assessed using a four-point scoring system. ST changes, heart rate and mean arterial pressure measured invasively before induction to five minutes thereafter [6 time point]. Data was analyzed using descriptive statistics, chi 2 and T tests, and frequency distribution tables. Tracheal intubation was successful in all patients without any problems. Intubation conditions were also clinically acceptable in all groups. Mean arterial pressure, HR and ST changes were not different between the groups significantly. It is concluded that varying doses [2-4[micro/kg] of remifentanil administered before propofol provides acceptable tracheal intubation condition and hemodynamic changes comparing to conventional technique in patients with coronary artery disease

[Comparison of incidence of succinylcholine-induced fasciculation and postoperative Myalgias]

Fasciculation and myalgia are common complications of succinylcholine and decrease of incidence and intensity of them will reduce succinylcholine-induced side effects. This study was done to evaluate the severity and prevalence of fasciculation and myalgia after succinylcholine and perform a comparison between three groups. In this case - control study in 2006, 75 patients with ASA I and orthopedic surgery were evaluated in Imam Reza hospital. The patients divided randomly in to three same groups. In first group thiopental and succinylcholine 1.5 mg/kg was injected, in second group propofol 2 mg/kg and succinlycholine 1.5 mg/kg and in third group thiopental and succinylcholine 3 mg/ kg was administered. Fasciculation, intubation quality after 1 min, and myalgia after 24 h were analyzed. Demografic parameters, pain scales and fasciculation data were gathered in a questionnaire and analyzed by SPSS, descriptive statistics and frequency distribution tables. Fasciculation rate was%76 in first group, 80% in second group, and%84 in third groups. Myalgia was%24 in first group,%28 in second group, and%20 in third group. There were no significant differences between group 1 and 2 and also 1 and 3 with respect to fasciculation, Intubation, and post-operative myalgia. We concluded that propofol aggregates muscular relaxation versus thiopental, and low-dose versus high-dose of succinylcholine and chang to phase II block had no differences regarding to these complications

[ report of three cases with negative pressure pulmonary edema]

Negative pressure pulmonary edema [NPPE] is a relatively rare event complicating GA which occurs following airway obstruction despite the patient's effective attempt to inspire and ultimately high negative pressure inside airways. This results in fluid transudation into the interstitial tissue and alveoles. The prevalence of NPPE is less than 0.1%. This article aims to give more information about NPPE as a leading cause of pulmonary edema following airway obstruction after GA. Also discussed in this article are diagnosis and how to differentiate it from aspiration pneumonia as well as the appropriate treatment. Three patients were evaluated. The mild form presented with hypoxia who had findings at the auscultation of lungs; the severe form manfiested with symptoms and signs characteristic of pulmonary edema. Airway obstruction and laryngospasm was due to the irritation secondary to the tracheal tube in the first case, post-tonsillectomy bleeding in the second case and increased secretions in the third one. Patients were treated with oxygen, mechanical ventilation, steroids, diuretics and aminophylline. They experienced no complications thereafter. The most important point in diagnosing NPPE is to hold it in mind when encountering such a problem. NPPE is seen more in healthy athletic young patients. Care must be given to the patients at risk. Rapid relief of upper airway obstruction, restoring of patient's ventilation, FiO2 increment and the application of CPAP- PEEP are the cornerstones of treatment