[Presenting features and outcome of rhino-orbital-cerebral mucormycosis in two referral center in mashhad]

This study was done to determine presenting features and treatment outcome of Rhino-Orbital-Cerebral Mucormycosis [ROCM]. This cross sectional study was conducted during 14 years [from 1998-2012] in two educational hospitals of Mashhad University of Medical Sciences in patients with rhino-orbital-cerebral mucormycosis. Clinical symptoms, predisposing factors, demografic parameter and treatment outcome were collected by SPSS and analyzed by cox regression model. A total of 123 cases were [92 proven, 1 probable, 30 possible]. From 92 cases of proven rhino-orbital-cerebral mucormycosis, 52% men and 48% women were recorded. The most risk factor were diabet 42.4% and immune deficiency 38%. From which 32 patients have hematologic malignancy [50% ALL, 37.5% AML, 6.3% aplastic anemia, 6.3% other]. Mean time of admission in hospital were 30.1 +/- 29.3 days [1-230 days]. The sign and symptoms were fever 41.3%, nasal ulceration or necrosis of palate 54.3%, orbital sign 59.7%, Headache 55.4%, central nervous system sign 28.2% and facial sign 53.2%. Median time between first symptoms and start of amphotricin B was 8.2 +/- 8.6 days. Treatment consist of both surgery and amphotricin B was done in 70.5% of patients. Mean number of surgery were 1.8 +/- 1.5. The mean time of mortality was 60.3 +/- 83 day. Thirty seven percent of patients survived with a 6 months follow up. Initial symptoms of sinus invasion by mucormycosis are indistinguishable from other more common causes of sinusitis. We must consider these diseases if there is nasal ulceration or necrosis of palate with fever and orbital sign. Diabet and immune deficiency are the most risk factor for rhino-orbito-cerebral mucormycosis. There is no relationship between age, predisposing factors and adverse effect of drugs with survival. Progression to central nervous system in imaging pattern are related with hospital mortality. Treatment modality and number of surgery affect to mortality P=0.001, P=0.033. Survival was affected with the total dose of amphotericin B [P=0.026]

Comparison of low dose intradermal with high dose intramuscular hepatitis B vaccination in hemodialysis patients

Hemodialysis patients have a low immune response to the hepatitis B [HB] vaccine. The method of administration plays an important role in immune response establishment. This case control study compares the efficacy of intradermal [ID] and intramuscular [IM] injection methods for the HB vaccine. This study was undertaken in hemodialysis centers. We recruited 50 patients after excluding those with histories of previous HB vaccination, immunosuppressive therapy, and who were positive for HBsAb, HBsAg, and HCV antibody. Patients were randomly assigned to receive HB vaccine by either the ID or IM injection methods. The timeline for vaccine administration was 0, 1, 2 and 6 months for both groups. The ID group received 2 microg of EngerixB in both the right and left anterolateral forearms, for a total dose of 4 microg; the IM group received 20 microg in two sites in the deltoid muscle, for a total dose of 40 microg. We measured HBsAb titers at the third and seventh months following the first doses of HB vaccine. In the third month after the first HB vaccination, 40.4% of the patients reached HBsAb levels of at least 10 mIU/ml in the ID group versus 60.9% in the IM group. At the seventh month following the first HB vaccination, 68% of patients reached HBsAb levels of at least 10 mIU/ml in the ID group versus 68% in the IM group. However the mean HBsAb titer in the ID group was 459 +/- 323.8 versus 294.6 +/- 277.5 mIU/ml in the IM group. There was no significant relation between seroconversion rates for both injection methods. However the mean titers of HBsAb for both the third and seventh months after the first HB vaccination in the ID group were more than the IM group. The cost for the low dose HB vaccine in the ID group is less than the high dose vaccine for the IM group. Thus, it is beneficial to use the ID low dose HB vaccine for underdeveloped countries.

[Epidemiologic evaluation and some species in injection drug users that admitted in infectious department of Imam Reza hospital [2007-2009]]

Infections are considered as the most common reason of referral and hospitalization in Intravenous [IV] drug abusers. This study has been conducted to clarify epidemiologic specification of these patients including their personal details [age, sex, education, etc.] and type of the drug injected and their most common infections. This descriptive cross-sectional study has been conducted in Infectious Disease Department of Imam-Reza Hospital between 2007 to 2009 in Mashhad. 62 drugs users were enrolled in study and personal IRAN and epidemiological details, symptoms, mode of addiction and their complications were collected through questionnaires. Data were analyzed by descriptive statistical methods and frequency tables. The study revealed that crystal is the most common used drug [83.9%], followed by Heroin, Norchizak and Tamchizak, and Sheereh [a remnant of opium]. The most common reason for admission was skin and soft tissue infection [33%]. Anti HCV, Anti HIV, HBSAg, and Anti HTLV1 were positive in 71%, 14.5%, 8.1%, and 8.1%, respectively. In this article, unlike other surveys around the world, the most common type of drug used for injection was crystal and the degree of HCV positive cases was higher than similar studies in Iran. High prevalence necrotizing fasciitis, higher percentage of gram Negative bacillus in blood cultures as well as greater number of HCV positive, are probably due to the crystal usage. Hence, it seems reasonable that more advanced studies should be conducted in this regard

[Central venous catheter related infection among patients on hemodialysis]

End Stage Renal Disease [ESRD] patients need vascular access for hemodialysis and infection is the most common late complication of central venous catheters. A descriptive prospective study was done on hemodialysis patients to evaluate the prevalence of the catheter-related infections. Patients with possible central venous catheter infection were enrolled from July 2009 to April 2011 at Imam Reza Hospital, Mashhad. We checked the apparent exit site infection as well as the systemic signs and symptoms of catheter-related infection. Specimens were obtained from the catheter blood, the catheter tip and the peripheral blood for culture and antibiogram. Then data was collected by using SPSS. Frequency tables, graphs and mean were prepared for describing data. From total 65 hemodialysis patients [34 females, 31 males with a mean age of 54.9], 41 ones [63/1%] had a past history of catheter-related infection. As for the local signs of infection, 52 patients [80%] had tenderness, 41 [63.1%] had induration, 35 [53.8%] had redness and 32 ones [49.2%] had pus discharge from the catheter insertion site. Staphylococcus aureus was the prevalent organism among 76.7% of patients with positive culture out of which 79.6% were vancomycin sensitive. Catheter had to be removed in 21[33.3%] of the dialysis patients. Staphylococcus aureus was the most common organism involving in catheter-related infection among hemodialysis patients and the most common clinical sign of infection, was tenderness at the catheter insertion site. We suggest that these findings could be used for early diagnosis and starting the empiric antibiotic regimen in patients with central venous catheters

[Brain computed tomography scan in meningitis patients with deterioration of consciousness]

Due to life-threatening complication of LP in patients with deterioration of consciousness due to meningitis [=brain herniation] the LP procedure safety without brain CT scan is debated. This descriptive cross-sectional study was done on patients suspected of meningitis with decreased consciousness referred to the infectious emergency of Emam Reza Hospital, Mashhad, Iran from April 2006 to March 2008. All patients underwent physical examination [neurologic and ophthalmoscopic] of the patients by residents of infectious diseases. Data [results of physical examination, neurologic, ophtalmoscopic, brain CT scan and LP] were collected. Then statistical analysis was performed with SPSS software and descriptive statistical methods. 136 patients were evaluated. The mean age of patients was 43.88 +/- 21.185 years and 58.5% [24] of the cases were male. The result of brain CT was normal in 53.7%. The most frequent abnormal brain CT results were hypodencity lesions [12%]. 2.4% [1] of patients had abnormal CT-Scan with space occupying lesion with mass effect and midline shift, and final diagnosis was brain abscess due to chronic mastoiditis. This study showed that abnormal finding of brain CT-Scan in adult meningitis with loss of consciousness is approximately 50% and mass effect was seen in 2.4% of patients

[Evaluation of etiology of infectious diseases in elderly patients admitted to the infectious ward of Imam Reza hospital]

It is estimated that by the year 2050 about 20% of the world population are 65 years or older. Infections are cause of 30% of mortality in this age group. Impairment of Cellular and humoural immunity, reduced physiological reflex, increased prevalence of chronic diseases and so forth are possible for increased frequency of infection in the elderly. This descriptive study was performed on 272 elderly patients, admitted to the Infectious Diseases ward, Imam Reza hospital of Mashad, the most important clinical and paraclinical findings and final diagnosis were collected by SPSS and analyzed with T-Test, Chi-Square and Fisher's Exact Test. Approximately 31% of patients admitted during one year in infectious Diseases ward were old people. Of these 53% were female and 47% were male. The most common complaints of patients were respiratory problems [45%] and the most common diagnosis was pneumonia [%43]. AL together 39% of patients changed in mental status and 51% suffered a chronic medical disease. Mortality rate in patients was 19/5%. Seems infection to be one of the common causes of hospitalization in the elderly and despite amenity of modern methods and new antibiotics; it accompanies a high mortality rate in this age group. Attention to the danger signs and risk factors such as age, decreased level of consciousness, immune deficiency and early treatment may reduced mortality in these patients