Comorbidity of hepatocellular carcinoma and multiple huge Hydatid cysts in the liver

Hydatid disease is still an important health problem in the world. It is prevalent in the most countries in Asia, Middle East, Australia, and Eastern Europe. Due to the vital cycle of the parasite, the liver is a more common site than other organs. However, multiple huge cysts of liver are rare, especially when it is observed with liver malignancy. Here in, we report a 33-year-old woman with comorbidity of multiple huge cysts and hepatocarcinoma

Hepatitis in patients with crimean -congo hemorrhagic fever

Crimean-Congo hemorrhagic fever [CCHF] is a viral disease and causing approximately 30% fatality rate. Recent studies have been reported that hepatitis in CCHF patients is with high mortality. The aim of this study was to determine the prevalence of hepatitis in the CCHF cases and also detect the mortality rate among patients with hepatitis. The present study was conducted in patients with CCHF who were hospitalized in Boo-Ali hospital in Zahedan between Oct 2009 to Feb 2012. Liver function tests including aminotransferase enzymes and prothrombin time and mortality rate were evaluated. Among 53 patients with CCHF, hepatitis was seen in 19 patients [45%]. Nine patients died [21%]. All dead patients had a serum aminotransaminase level >/=10 times the upper normal limit. Our study showed that hepatitis is prevalent in CCHF patients and a serum aminotransaminase level >/=5 times the upper normal limit [UNL] is a risk factor for severe disease and high mortality

case of fascioliasis from south-east of Iran

Fascioliasis is a zoonotic infection caused by Fasciola hepatica. Human is accidentally infected by ingesting contaminated drinking water or plants in endemic area [mainly North of Iran]. The disease is usually reported from the sheep raising area of our country. We report a case of human fascioliasis in south-eastern Iran with dry climate without any history of travel to endemic regions

[Crimean -Congo Hemorrhagic Fever]

Crimean-Congo Hemorrhagic Fever [CCHF] is an acute viral hemorrhagic disease which is transmitted to humans by the bite of the Hyalomma tick or by direct contact with blood of an infected animal or human. CCHF was first recognized in the Crimean peninsula in the mid-1940s, and the same virus was isolated from a patient in Democratic Republic of Congo, in 1956. Person-to-person transmission of CCHF virus occurs through direct exposure to blood or other secretions; in addition, nosocomial transmission is well-documented with case fatality rates ranging from 30 70%. Tick bite is one of the most important risk factors for CCHF acquisition and Hyalomma tick is its main reservoir in the nature, but many domestic animals including cattle, sheep, goats, hare, buffalo, and even ostrich can be infected by this virus. Disease in animals is subclinical and they are infected only for one week. During the viremia phase, direct exposure to blood or other secretions can infect human. Hyalomma ticks favor dry climates and arid-type vegetation, and are abundant in European countries bordering the Mediterranean Sea; numerous animals may act as CCHF virus hosts. In recent years, a number of cases have been reported from Africa, Eastern Europe and Asia. Healthcare workers are also at risk of infection through unprotected contact with infected blood and other body fluids. Incubation phase is about 3 to 4 days after tick bite and 3-14 days when the patient is exposed to infected blood and other body fluids. Typical CCHF progresses rapidly with high fever, malaise, severe headache, myalgia, and gastrointestinal symptoms like abdominal pain and nausea. CCHF is confirmed either by detection of specific immunoglobulin M antibodies or a four-fold increase of immunoglobulin G titers using enzyme-linked immunoassays, indirect immunofluorescent assays, or through RT-PCR. Supportive therapy is an essential part of the case management. Intensive monitoring of fluid volume and blood component replacement is recommended. Oral ribavirin is the therapy of choice in the clinical practice. If the patient meets the criteria for probable CCHF, treatment with ribavirin protocol needs to be started immediately. Interferon and Immunoglobulin have significant antiviral activity in vitro against CCHF. Recently, we face many cases of CCHF in several provinces of Iran. The aim of this article is to review clinical manifestations, treatment and prevention of this disease

Evaluation of active tuberculosis case finding in Shirabad region of Zahedan

One third of world population is infected with TB germs. If untreated, each TB patient infects 15-20 people. Therefore, the rapid diagnosis of infectious TB patients is the basis to prevent from tuberculosis. Therefore, proper utilization of the methods of TB disease is very important. This study was conducted to evaluate the efficacy of active intervention in high risk areas of Shirabad of Zahedan city. In this study, two methods of house to house visit and face to face training were used to. All residents of above 6 of Shirabad, who were 55845 people, were examined for tuberculosis from mid-July to December 2008 [with emphasis on the detection of pulmonary TB]. The evaluation was performed based on clinical symptoms [more than 2 weeks coughing], sputum smear and chest radiography. Data collected analyzed by the software SPSS-13. Infectious TB disease had a significant increase within 2 years [320% in 2007 and 500% in 2008 [p=0.001]. The incidence was significant in different nations. It had significant increase in Iranian population [p=0.001] and significant decrease in non-Iranian population [p=0.001]. Reduced delay in diagnosis of non-Iranian women made smear significantly positive [p=0.014]. The results showed that active intervention is effective in the discovery of infectious TB cases with 100% efficiency of passive TB screening. To treat patients effectively, efficient and effective DOTS strategy is the main underlying prerequisite for active intervention.

Effect of cigarette smoking on sputum smear conversion time among adult new pulmonary tuberculosis patients: a study from Iran Southeast

Cigarettes smoking is a risk factor for tuberculosis [TB]. Associations between smoking and TB disease have been reported, but there are few reports on the influence of smoking on the sputum smear and culture conversion time. This study surveyed the possible association between smoking and sputum smear conversion time among new smear-positive pulmonary tuberculosis patients, Between May 2005 and December 2006, we evaluated smokers and non-smokers patients with pulmonary TB referred to Zahedan Tuberculosis Center [Southeastern Iran]. Patients were not immunosuppressed or infected by human immunodeficiency virus [HIV]. Drug resistant cases were also excluded. A total of 200 TB patients, including 100 smokers, were evaluated. There was a significant delay in sputum smear conversion time between smokers and non-smokers 2 [53% vs. 10%, respectively, p<0.001] and 3 months following the treatment [19% vs. 2%, respectively, p<0.001]. However, there was no significant difference in failure rate [a positive smear at the end of the 5[th] month of treatment] between two groups [95% vs. 97%]. Our results revealed that smoking is significantly associated with a delay in sputum smear conversion time, hence, pulmonary TB cases must be strongly encouraged to cease smoking

outcome of patients with crimean-congo hemorrhagic fever in Zahedan, southeast of Iran: a comparative study

Crimean-Congo hemorrhagic fever was rarely reported from Iran before 1999. In a recent outbreak, the disease has been reported from different provinces of Iran, especially from Sistan and Baluchestan. Ribavirin has been recommended by World Health Organization as a potential therapeutic modality for Crimean-Congo hemorrhagic fever. This study was conducted to determine the clinical outcome and the effect of ribavirin in two groups of patients with Crimean-Congo hemorrhagic fever who were treated at different times. In this cross-sectional study, we evaluated patients with Crimean-Congo hemorrhagic fever who were admitted to Boo-Ali Hospital in Zahedan, a subtropical area in southeastern Iran, at the first three years after beginning of the last outbreak [1999 - 2003] and those who were admitted during 2005 - 2007. First, we found all patients with confirmed Crimean-Congo hemorrhagic fever infection who were treated with oral ribavirin. Then, they were evaluated for recovery and mortality rate. We evaluated 123 patients with confirmed Crimean-Congo hemorrhagic fever infection [91 patients treated between 1999 and 2003, and 32 patients between 2005 and 2007]. Among the 91 patients, 73 [80%] survived, and 18 [20%] died of the disease. During 2005 - 2007, among the 32 patients who were treated within three days of onset of the disease, only one [3%] died of the disease. The recovery rate was higher among patients who were admitted during 2005 - 2007 than those hospitalized between 1999 and 2003 [97% vs. 80%]. There was a significant [P=0.001] difference in the mortality rate between the two groups. Prompt treatment with oral ribavirin can increase the recovery rate in patients with Crimean-Congo hemorrhagic fever

Hospitalization among diabetic adults due to infectious diseases in Zahedan

In vitro evidence shows that immune function is compromised in people with diabetes. Therefore, infections are more common and infection-related mortality is higher in this group. Accurate information about the prevalence of infectious diseases in diabetic patients can help in health care policy and support planning. We do not know the spectrum of clinical infectious diseases in our patients. This study was conducted to determine the most common infectious diseases in diabetic patients. In this cross-sectional study all diabetic patients who were admitted to our hospital in Zahedan [Southeastern Iran] between 2001 and 2006, were evaluated. At first, we selected all of the patients with diabetes. Then all patients files were reviewed retrospectively for demographic factors and duration of diabetes, type of diabetes, cause of admission, prevalence of infectious diseases, duration of hospitalization and mortality rate. A total of 112 patients with diabetes [45 males and 67 females with an age range of 10 to 80] were evaluated. Pneumonia, diabetic foot and tuberculosis were the most common infections. Seventy percent of cases had type 2 diabetes. Duration of hospitalization was between 1 to 20 days. Upon the results emerged from this study, infection is the most frequent cause of hospitalization and death in the diabetic patients. Control of the disease, good health care system and vaccination can decrease the rate of infectious diseases

Osseous hydatid disease

A 48-year-old man referred with pain and swelling at the upper and middle third of left tibia with a history of previous osseous hydatid disease three years ago. Despite surgical procedure which was performed in this case, recurrence was observed and repeated exploration with wide resection and oral medical therapy were recommended. Bone hydatid cyst is an uncommon disease with difficult response to treatment. Hydatid disease should be included in the differential diagnosis of cystic lesions of bone in endemic regions

Clinical manifestations, laboratory findings and clinical outcome in 6 pregnant women with Crimean-Congo hemorrhagic fever

Crimean-Congo hemorrhagic fever [CCHF] is caused by Nairovirus, genus Bunyavirus in family of bunyaviridae, and is spread by the tick Hyalomma spp or via blood transfusion and contaminated blood of human and animal. During the recent years, disease has been reported from Iran, especially from Sistan and Baluchestan, Isfahan, Kermanshah and Kohkilouyeh-bouyerahmad provinces. Now, CCHF is endemic in Sistan and Baluchestan province, the resent study describes the clinical features of CCHF among pregnant women. We report our experience with six pregnant women with CCHF, who were admitted to Boo-Ali hospital during 2000 to 2005. All patients were treated by Ribavirin. We studied the clinical manifestations, laboratory findings and clinical outcome of disease in all cases. Our results showed that, fever, headache, myalgia and gingival bleeding were the most common clinical manifestations. Thrombocytopenia, anemia and decreased protrombin time were the commonest laboratory findings. Abortion was observed in 3 patients and stillbirth in one patient. In fact, 66.6% of pregnant women had fetal loss. It is found that fetal loss is high in CCHF parturients, however, it should be further studied in endemic areas

Comparison of ultrasonographic measurement of the tuberculin skin test with the result of manual reading

This study was conducted in order to determine the ultrasonographic [US] finding of tuberculin skin test and to compare with the result of manual reading. One hundred of hospital staff, in Zahedan a city in Southeast of Iran, were enrolled in this study. A 5-tuberculin unit [TU] PPD Mantoux test was administered to all healthy subjects by two experienced nurses and was applied to the left forarm. At 48 and 72 h, all PPD skin tests were measured by two independent readers and one Radiologist by High-resolution US examinations. Then results was analysed and comparison on results was made. A difference with p<0.05 was considered significant. Fifteen cases had no induration measurable either manually or by US at 48 and 72 h. At 48 and 72 h, 12, 13 cases had induration between 1-4 mm by the first reader and 11,13 had also induration between 1-4 mm as reported by the second reader. At 48 and 72 h 18, 19 cases had an induration between 5-9 mm by the first reader and at these times, 20, 23 cases had an induration between 5-9 mm by the second reader. At 48 and 72 h, 36, 35 cases had an induration between 10 to 14 by the first reader and at theses times, 35, 32 of healthy subjects had induration between 10-15 by the second reader. At 48 and 72 h, 17,15 cases, had a PPD skin test more than 15 mm, by two manual readers. On US, only 2 cases who had no induration by two readers at 48 and 72 h, showed an induration between 3.5 to 4.5 mm. There was no significant difference between reader 1 and reader 2 with US reader at 48 and 72 h [p>0.05]. Also, there was no significant difference between two manual readers at 48 and 72 h, [p = 0.1, p = 0.09]. Result showed that manual finding of TST can be simply and objectively measured in the subjects who should start prophylactic antituberculous especially in children less than 6 year who have a history of contact with tuberculous patients or in patients who should start on tuberculosis treatment immediately

Immigrant fathers, mothers and babies who are living with HIV/AIDS

In this cross-sectional, descriptive study, in a time period of 5 months in 2005, in Zahedan [Southeast of Iran], we evaluated the prevalence of HIV/AIDS in the families of the men with HIV/AIDS who had a history of immigration to other countries to work. Blood samples of the mothers and the babies were evaluated by ELISA method and in those who had a positive test, results were confirmed with a more specific assay [western blot]. Among 274 patients with HIV infection/AIDS[224 male and 50 female] in Sistan and Baluchestan Province in Southeast of Iran, 65 cases [41 male, 24 female] were from Saravan [a city in Sistan and Baluchestan]. Out of 41 men with HIV/AIDS in Saravan, 21 cases had a history of immigration, to neighbouring countries to work. Forty five percent of mothers [11 cases] who had infected immigrant husbands, showed a positive test and they were infected with HIV. Also, HIV test was positive in 3 children of families whom their fathers were infected immigrants. Present study showed that 45% of the mothers and 2.5% of the babies in families who the fathers were infected and had a history of immigration, had a positive test and they had been infected with HIV infection. Fifty percent of men with HIV/AIDS had history of immigration. Upon this results, immigration and family deprivation is a potent risk factor for occurrence of infection

Prevalence of parvovirus B19 infection in successful and unsuccessful pregnancy in Zahedan, Southeast of Iran

To determine the seroprevalence of PVB19 infection in obstetric population, present research was conducted in Zahedan at the southeast of Iran from 2001-2002. In this case-control study, we assayed both virus specific anti-IgG and anti-IgM antibodies among 168 women with term pregnancy [controls] and 156 women with pregnancy loss at first and second trimester [cases] by ELISA method. PVB19Anti-IgG positive rate was 21.8% in pregnancy loss [case] and 20.8% in term pregnancy [control]. Parvovirus B19 IgM antibody was detected in 10.3% of case and 6.5% in control. Although specific Parvovirus B19 IgG and IgM antibodies had no statistically significant difference between two groups by the age and parity, but our study showed that the prevalence of parvovirus B19 IgM antibody was higher in women with unsuccessful pregnancy. It is considerable, that high levels of IgM antibody probably support the association between PVB19 infection and unsuccess-pregnancy

Which equipments are more infected with hepatitis B virus infection? Dental equipments or endescopes?

Hepatitis B Virus infection [HBV] is a significant hazard in the dental environment and endoscopy room because the virus may be transmitted through contaminated instruments. This study was conducted in order to detect the HbsAg in the endoscopy and dental equipments and then to compare the results. In this cross-sectional study, in a time period of 30 days, 100 and 50 specimens were obtained randomly from multiple apparently sterile dental equipments and endescopes, respectively. Obtained samples evaluated for HBsAg by ELISA method [Sorin biomedical Kit]. Results of the present study shows that 2% of instruments used for dental treatment was infected with hepatitis B virus. Among 50 specimens of endescope instruments, only one sample was positive for HBsAg. Upon our results, there might exist the possibility of HBV transmission through dental equipments and endoscope instruments. We advise the use of standard sterilization for prevention of transmission of hepatitis B virus infection

Spectrum of clinical disease in a series of hospitalized HIV-infected patients from southeast of Iran

To determine the pattern of opportunistic infections [OIs] and non-infectious opportunistic diseases in hospitalized HIV-infected patients in Zahedan, southeast of Iran. We retrospectively reviewed the records of 52 HIV-infected patients [47 male, 5 female; age range, 21-54 years] who were admitted to Boo-Ali Hospital, Zahedan, Iran for evaluation and management of an HIV-related disorders from April 2000 to December 2005. Tuberculosis [TB] was the most common opportunistic infections [53.8%] followed by hepatitis C [11.5%], typhoid [9.6%], amebiasis [9.6%], candidal esophagitis [5.7%], acute bacterial pneumonia [3.8%], and cerebral toxoplasmosis [1.9%]. Most of the cases of TB were pulmonary [36.5%]. Apart from other well-recognized OIs, 2 cases of HIV-associated lymphoma were encountered. Only 12 patients [23.07%] received antiretroviral therapy. Five patients [9.6%] died during hospital stay due to tuberculosis [4 cases] and typhoid [1 case]. The findings show that opportunistic infections are common in HIV-infected patients in Zahedan, southeast of Iran. Tuberculosis remains the most common OIs and is the most common cause of death in these patients

Compartment syndrome: a very rare complication of Crimean-congo haemorrhagic fever

Crimean-Congo haemorrhagic fever [CCHF] is a worldwide distributed lethal disease. Miscellaneous complications have been reported, however, compartment syndrome is a very rare complication. We report two cases of compartment syndrome of the left and right upper limbs following haemorrhage due to Crimean-Congo haemorrhagic fever. These cases suggest that CCHF should be included in the differential diagnosis of patients with compartment syndrome. Patients are at risk of developing compartment syndromes especially in the forearm. We emphasize the importance of clinical signs in the early diagnosis of this potentially serious complication of viral haemorrhagic fever

Recurrent non-typhoidal salmonella bacteremia in a patient with interleukin -12p40 deficiency

The South eastern region of Iran is an endemic area for salmonellosis. Sometimes bacteremia due to nontyphoidal salmonella occurs but certain patients are at increased risk for recurrent bacteremia. The risk of invasive salmonellosis and recurrent bacteremia is increased in the patients with immunosuppression, especially impaired cell-mediated immunity, lymphoproliferative diseases and in patients with IL-12 deficiency. In recent years, a series of inherited disorders of IL-12-IFN-gamma axis have been described that predispose affected individuals to disseminated disease caused by environmental mycobacteria and non-typhoidal salmonella. We report here the first such patient originating from and living in Iran. The patient was a 26-year-old man, suffering from IL-12p40 deficiency and presented with recurrent episodes of systemic salmonellosis. This report indicates that there are patients with inherited defects of the IL-12-IFN-gamma circuit in Iran. We recommended to consider this group of disorders in all patients with recurrent non-typhoidal salmonella bacteremia, wherever they are found

Prevalence of hepatitis B surface antigen in pregnant women in Zahedan, Iran

Introduction: hepatitis B virus is one of the most common chronic infections in the world. Over half of the world population has been exposed to this virus. It is estimated that 3% of Iranian population are - chronic carriers

Objective: to determine the seroprevalence of hepatitis B infection in pregnant women in Zahedan, Iran

Method: in this cross-sectional study in a period of one month in Zahedan, total cases of 200 pregnant women were enrolled in our study. Sera obtained from these pregnant women were evaluated for HBsAg by ELISA method

Result: our data showed that 6.5% of the pregnant women had a positive test for HBsAg

Conclusion: it seems that hepatitis B infection is highly endemic at least in pregnant women in Zahedan. On the basis of these epidemiologic data, screening of all pregnant women is necessary