Chronic recurrent multifocal osteomyelitis: a case report

Chronic recurrent multifocal osteomyelitis [CRMO] is a rare inflammatory bone disease. It is a diagnosis of exclusion based on the clinical, radiological and pathological criteria. The awareness of the corresponding feature can help avoid of unnecessary diagnostic procedures and prolonged antibiotic therapy. We present a case of 4.5 year old girl, diagnosed with CRMO who were followed for 6 months as a case of chronic bacterial osteomyelitis and received long course of antibiotic therapy

Epidemiology of tuberculosis among Afghan immigrants in Fars province, southern Islamic Republic of Iran

Rates of tuberculosis are high among migrants from high-incidence countries. This study determined the epidemiology of tuberculosis among Afghan immigrants in Fars province, southern Islamic Republic of Iran. From April 2000 to April 2002, all records were examined for new tuberculosis patients of Afghan origin registered at Shiraz University of Medical Sciences. A total of 371 patients [208 males, 163 females] were found: 74.9% pulmonary and 25.1% extrapulmonary cases. Of the 278 new cases of pulmonary tuberculosis, 157 [56.5%] were sputum smear-positive and 121 [43.5%] were sputum smear-negative. The incidence of tuberculosis per 100 000 Afghan population in Fars province was estimated at 96.2, 88.2 and 63.5 in 2000, 2001 and 2002 respectively

Knowledge and attitude of medical students and lecturers toward evidence-based medicine: evidence from Shiraz

The application of diagnostic, therapeutic, and prognostic evidence in day-to-day management of patients has been in constant focus during the last two decades. This study is an attempt to investigate attitude and knowledge of post-graduated medical students and lecturers towards evidence-based medicine [EBM] and assess their preferences to clinical practice guidelines. The designed questionnaire was posted to the randomly selected post-graduated medical students and lecturers of medical department at Shiraz University of Medical Sciences. There were one hundred sixty subjects [60%] who answered the questionnaire. Sixty nine percent were male, 46.3% were lecturers, and 53.2% were post-graduated medical students. About 66% of the respondents have heard of the term of EBM. Only 7.8% of the respondents have already attended to a course to learn the skills of EBM and one hundred twenty five [78.1%] like to attend a course to learn the skills of EBM. The most common perceived reason for use of EBM was lack of enough motivation. They have not yet integrated the use of EBM into their practices widely. Their knowledge is at a high risk of becoming out of data. Education of EBM should be a hot topic among educational planning programmers until it becomes apart of university educational curriculum in Iran

Evaluation of rK39 strip test for the diagnosis of visceral leishmaniasis in infants

This study estimated the sensitivity and specificity of the rK39 strip test compared with the immunofluorescent antibody test and microscopy of bone marrow aspirate smears [the gold standard] in 47 children with suspected visceral leishmaniasis. A control group of children with other diagnoses [tuberculosis, toxoplasmosis, systemic lupus erythematosus, malaria or cutaneous leishmaniasis] were also tested to check false positive results. The sensitivity and specificity of the strip test were 82.4% and 100% and that of immunofluorescent antibody were 100% and 92.7%. The rK39 strip test is reliable where there is no access to laboratory facilities

Prevalence of measles antibody in children of different ages in Shiraz, Islamic Republic of Iran

An outbreak of measles due to secondary vaccine failure prompted this investigation into the prevalence of measles antibody in children. We studied 608 children in 7 different age groups: 6, 9, 14 and 18 months and 6, 10 and 15 years. Children in the 2 youngest groups received no vaccination; the rest were vaccinated at 9 months and 15 months. The 15-year-old age group received an additional vaccination. Transplacental measles antibody [Ab] decreased from 10.0% at 6 months to 0% at 9 months. Measles Ab was positive in 52.9% [14 months], 89.4% [18 months], 60.8% 96 years], 45.0% [10 years] and 96.8% [15 years].To increase Ab levels, a booster vaccination is recommended, administered either with the second DPT booster or at pre-high school age

Prevalence of antibody to Brucella species in butchers, slaughterers and others

Brucellosis is being reported with increasing frequency in the Islamic Republic of Iran. Serum antibodies in high-risk and general populations help to define cut-off levels and can be used as a simple and rapid diagnostic tests in infected areas. We performed the rose Bengal test [RBT], serum agglutination test [SAT] and 2-mercaptoethanol [2ME] titre determination on 415 healthy individuals including butchers, slaughterers and others. Positive results were found by RBT, SAT titre [1:80] and 2ME titre >/= 1:20 in slaughterers [10%, 20% and 6% respectively], butchers [6%, 4% and 1% respectively] and the general population [1%, 2% and < 1% respectively]. A single SAT titre >/= 1:80 in the presence of 2ME titre >/= 1:20 can be diagnostic in this region

Active case-finding of communicable diseases in the South of the Islamic Republic of Iran

In the Fars province of the Islamic Republic of Iran, we established the Communicable Diseases Committee which determined 24 priority infectious diseases for active reporting. The Committee chose laboratory criteria for diagnosis of the selected diseases, trained reporters and follow-up staff and invited cooperation from heads of private and government laboratories. Cases were identified by the reporting staff and patients were interviewed by the follow-up staff, who also requested patients to complete an epidemiological questionnaire. Results were returned to the district health care centres and to the Committee for data analysis. Case-findings in 16 out of the 24 selected diseases showed an increase of up to 30 times compared to passive case-finding. This was due more to the greater efficiency of the method than to cohort epidemics

Childhood visceral leishmaniasis complicated by bacterial infections

Bacterial superinfection is one of the major complications leading to death in patients with visceral leishmaniasis. We studied the frequency and type of bacterial infection in 54 patients admitted to hospital with visceral leishmaniasis. The patients were children who ranged in age from 3 1/2 months to 7 years. Bacterial infections were found in 22 [41%] of the patients. Bacteria were isolated in patients with pneumonia, septicaemia, otitis media, urinary tract infections and skin infections. Enterobacteriaceae were the most common bacterial agents isolated. In infants with visceral leishmaniasis, fatal bacterial infections can be accompanied by nonspecific signs and symptoms. Thus, it is important to initiate antibiotic treatment early

Correlation between the severity of carditis and the level of acute phase reactants and anti-streptolysin O titer in acute rheumatic fever: a Retrospective study in Shiraz

In order to find the correlation between the severity of carditis in acute rheumatic fever [ARF] and the erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and anti-streptolysin O [ASO] titers, we performed a retrospective study in Shiraz on one-hundred and four patients. The mean age of the patients was 11 years. Fever was seen in 85.5%, arthralgia in 95.2%, arthritis in 81.7%, carditis in 82.5%, chorea in 3:8%, and subcutaneous nodules in 0.9% of patients. Mitral regurgitation was the most frequent valvar involvement [79.6%]. Sixteen patients [15.4%] had severe carditis. The ESR level was >/= 20 Wintrobe units in 98.0%, the CRP was elevated in 83.0%, and the ASO titer was >/= 400 Todd units in 91.0% of patients. There was no significant statistical difference between those patients with mild and severe carditis concerning the level of ESR, CRP, and ASO titers. There was also no significant statistical difference between the level of these parameters and the presence or absence of carditis, and the patient's age [8 years old]