[Rhinocerebral mucormycosis and treatment: Report of two cases]

Background and Aims: rhinocerebral mucormycosis is an aggressive fungal disease that involves the nose, par nasal sinuses, orbit and central nervous system. It may rapidly be fatal. The major route of infection is inhalation. This infection usually occurs secondary to immune suppression, diabetic ketoacidosis, and prolonged use of antibiotics, steroids, etc

Case report: we presented two cases of rhino cerebral mucormycosis with same presentation. Both patients had underlying disease [diabetes or immune deficiency]. The symptoms began including colds and sinusitis and was accompanied by pain and swelling in face. Smear of necrotic tissue showed branching nonseptated mycelium in favor of mucosal. These patients were treated Included Medical therapy with amphotericin-B and surgical treatment was undertaken to drain the sinuses

Conclusions: the diagnosis of rhino cerebral mucormycosis should be considered in the hospital in diabetic patients. Early diagnosis and treatment, treatment of the underlying disease are crucial factors leading to a good outcome

[Prevalence of congenital toxoplasmosis in two university hospitals: a brief report]

The incidence and clinical presentation of congenital toxoplasmosis in our newborns was not studied until yet. Goal of study is to evaluates the newborns for congenital Toxoplasma. Gondii infection and describe the clinical presentation from birth and follow up them. We conducted a prospective study upon 270 newborns were born in two university hospitals in Tehran [Rasoul akram and Akbar Abadi] during 2011-2012. Cord blood sample obtained from the newborns during labour. The samples centrifuged, transported and restored in -80 centigrade freezer in our Research Laboratory. Specific T.Gondii- antibodies [IGG, IGM] evaluated by ELISA methods. Neonates with positive T.Gondii- IGM diagnosed and studied as infected cases. The infected cases treated and followed for progression of disease. Gestational age of newborns was between 28-41 weeks. Positive T.Gondii - IGM and T.Gondii -IGG determined in 1.5%, 44.1% of cases respectively. The most common clinical presentation in seropositive cases was eye involvement [50%], and brain disorders [50%]. Positive PCR had not found in cerebrospinal fluids of seropositive [IgM] cases. One and a half percent of newborns were seropositive for T.Gondii. Wide variation of clinical presentation and early diagnosis of infected newborns in our country is so important. Adding the serologic tests [IGM] to neonatal screening test is recommended strongly.

Managerial factors affecting Tehran Heart Center performance: a study by Fuzzy Logic

Background: Hospitals play the most important role in health care system utilizing the majority of the health system resources. Appropriate and efficient management of hospitals could decreases the cost of diagnostic and therapeutic services while improve the quality of services. Efficient hospital management requires recognizing and prioritizing factors affecting hospital performance and choosing the correct interventions. In the current research managerial factors which affect Tehran Heart Center's [THC] performance were recognized and prioritized. Materials and Methods: A qualitative study using interview technique was performed in 2010 to identify managerial factors affecting T.H.C.'s performance. Top and middle line managers were included in this study. To prioritize the factors a questionnaire was designed and used. The results were analyzed by one sample t-test and Fuzzy DEMATEL techniques. Results: In this study 9 managerial factors affecting on T.H.C.'s performance were recognized which 7 of them were influencing based on the positive [Dƒfi-Rƒfi] and the others were influenced. The factors according to their intensity based on the quantity of [Dƒfi+Rƒfi]. So the influencing factors' ranking were as follow: delegation [3/16], management accountability [2/96], appropriateness of authority and responsibility [2/67], management motivation [2/61], process approach [2/26], systematic approach [2/25] and Top Management stability[1/68]. Conclusion: Paying more attention and focusing on the main influencing factors such as delegation, management accountability, authority and responsibility appropriateness, top management stability and management motivation, lead to higher performance in the hospitals.

study of the association between SNP8NRG241930 in the 5' end of neuroglin 1 gene with schizophrenia in a group of Iranian patients

Neuregulin1 [NRG1] gene is among the most promising candidate genes for schizophrenia. This gene is located on 8p22-p12, a region with a reported linkage to schizophrenia. Several studies have reported an association between schizophrenia and the 5? end polymorphisms in this gene. However, some studies have failed to confirm the role of NRG1 gene in the pathogenesis of schizophrenia. In the current study, we attempt to examine the association of SNP8NRG241930 from the NRG1 gene with schizophrenia in an Iranian population. It is noteworthy that there has been no report on the NRG1 association with schizophrenia in a population from the Middle East region. Genomic DNA samples were obtained via isolation from the peripheral blood cells of 95 unrelated subjects with schizophrenia and 95 matched healthy controls from southwest Iran. SNP8NRG241930 was genotyped by PCRRFLP using ScaI as a restriction endonuclease enzyme. Association of the SNP with schizophrenia was examined using the chi-square test. The frequency difference of alleles and genotypes between the two groups were compared. P?0.05 was considered significant. Statistical analysis on the studied polymorphism showed that both case and control groups were in Hardy-Weinberg equilibrium. The frequency of high risk allele [G allele] was 72.6% in patients, while this number was 56.8% in controls. The genotype frequencies in the patient group were as follows: GG [54%], GT [38%] and TT [8%] vs. genotype frequencies in the control group of: GG [26%], GT [63%] and TT [11%]. Considering allele and genotype frequencies, a significant association was observed between schizophrenia and SNP8NRG241930.The current study adds weight to the idea that some functional polymorphisms could exist in the 5? end of the NRG1 gene which increase susceptibility to schizophrenia. This is the first time that supportive evidence shows an involvement of the NRG1 locus in schizophrenia in an Iranian sample population

Outcome of surgical management of pterygium in Brunei Darussalam

Introduction A pterygium is an elevated, superficial, external ocular mass that usually forms over the peri-limbal conjunctiva and extends onto the corneal surface. It is more common in the tropics secondary to higher exposure to ultraviolet light. This study compares the various techniques of pterygium surgery including bare sclera, conjunctival autograft, and conjunctival mini-graft (with or without intraoperative Mitomycin C application) in terms of surgical outcome and recurrence rate and to identify the risk factors for recurrence and complications. Materials and Methods 959 patients operated for pterygium were retrospectively studied to determine the complications and recurrence rate after pterygium excision using the above mentioned surgical techniques. 625 (65.7%) were males. The mean age was 44 ± 12 years. Risk factors for recurrence were also studied. Results The recurrence rate of pterygium was 17.4%. There was no significant difference between the three surgical techniques in terms of recurrence rate (p = 0.28). Younger age was associated with higher recurrence rate (p = 0.001); There was no significant correlation between gender and recurrence of pterygium (p = 0.48). The bare sclera recurrence developed after a longer period of time compared to conjunctival grafts (p = 0.002). The commonest complication was granuloma (3.9%), followed by scleral thinning and/or melting (1.4%). Conclusion The study showed no statistically significant difference in terms of recurrence rate between the three pterygium surgical procedures studied. However, among cases of recurrence, those following bare sclera technique showed delayed recurrence compared to conjunctival autografts and conjunctival minigraft. The use of Mitomycin C adjunctive therapy was associated with significant reduction in recurrence rate. On the other hand, younger age group was associated with significantly higher recurrence rate.

Altered levels of nodal excitability by rate-dependent inhibitory effects of essential oil of Citrus aurantium on the electrophysiological properties of isolated perfused rabbit AV-Node: protective role in the prevention of ouabain toxicity / Alteración de los niveles de excitabilidad nodal por efectos inhibitorios velocidad-dependiente del aceite esencial de Citrus aurantium sobre las propiedades electrofisiológicas del nodo AV Aislado y perfundido de conejo: papel protector en la prevención de toxicidad por ouabaína

Treatment of supraventricular arrhythmia includes a wide range of medical interventions. Herbal remedies are suitable alternatives to synthetic drugs due to their availability, minimal side effects and lower price. Pharmacological studies and traditional medical literature point to the cardiovascular effects of Citrus aurantium L. (Rutaceae) in many instances. In the present study we used isolated perfused AV-node of rabbit as an experimental model to determine the effect of various concentrations of essential oil of C. aurantium (0.1-0.3 v/v) on the nodal conduction time and refractoriness of an isolated rabbit AV-nodal preparations. Selective stimulation protocols were used to independently quantify AV nodal recovery, facilitation and fatigue in 18 rabbits. Our results showed concentration-dependent and rate-independent suppressive effects of essence of C. aurantium on the Wenchebach cycle length (WBCL), AV Conduction Time (AVCT) and effective and functional refractory periods (ERP & FRP). Functional properties such as facilitation and fatigue were significantly increased by this plant. Citrus aurantium plays a protective role against the toxic effects of ouabaine by increasing AV nodal conduction time and refractoriness. The above results indicated differential effects of C. aurantium on slow and fast pathways, with a dominant role on fast pathways. This research has explained the protective role of C. aurantium on ouabaine toxicity. All results indicated the potential anti-arrhythmic effects of C. aurantium in treating supraventricular tachyarrhythmia.

El tratamiento de la arritmia supraventricular incluye una amplia gama de intervenciones médicas. Los remedios herbarios son alternativas adecuadas a las drogas sintéticas debido a su disponibilidad, con escasos efectos secundarios y bajo precio. Estudios farmacológicos y la literatura médica tradicional señalan los efectos cardiovasculares de Citrus aurantium L. (Rutaceae) en muchos casos. En el presente estudio se usaron aislados perfundidos del nodo AV de conejo como modelo experimental para determinar el efecto de diferentes concentraciones de aceite esencial de C. aurantium (0,1-0,3 v/v) sobre en el tiempo de conducción nodal y refractariedad. Un protocolo de estimulación selectiva se utilizó para cuantificar de forma independiente la recuperación, la facilitación y la fatiga del nodo AV en 18 conejos. Nuestros resultados muestran efectos supresores dependientes de la concentración e independiente de la velocidad de la esencia de C. aurantium sobre la duración del ciclo Wenchebach (WBCL), tiempo de conducción AV (AVTC) y períodos refractarios eficaz y funcional (PRE y PRF). Propiedades funcionales tales como la facilitación y la fatiga se incrementaron de manera significativa por esta planta. La Citrus aurantium juega un papel protector contra los efectos tóxicos de ouabaína al incrementar el tiempo de conducción AV nodal y la refractariedad. Los resultados indican efectos diferenciales de C. aurantium sobre las vías lentas y rápidas, con un papel dominante en las vías rápidas. Esta investigación ha explicado el papel protector de C. aurantium sobre la toxicidad ouabaine. Todos los resultados indican los posibles efectos anti-arrítmicos de C. aurantium en el tratamiento de taquiarritmias supraventriculares.

Sudden onset of unilateral blindness (Answers)

(Refer to page 131) Answer: Left Non-arteritic Anterior Ischaemic Optic Neuropathy (AION) Panel A shows a normal right fundus with a normal optic disc and retina, and the left fundus (Panel B) showing sectoral optic disc swelling with corresponding flame-shape haemorrhage.

Sudden onset of unilateral blindness

A 63-year-old gentleman presented with a two-day history of sudden, painless blurring of vision in the left eye, immediately after waking up in the morning. He is known to have had diabetes mellitus and hypertension for seven years, and a recent attack of angina pectoris. There was no history of trauma and no associated neurological abnormalities. Visual acuity was 6/6 in the right eye and ‘Counting Fingers' in the left eye. Ocular examination was normal in the right eye (Panel A). Pupil examination of the left eye (Panel B) showed the presence of a relative afferent pupillary defect (RAPD), in addition to the above shown abnormality in the fundus. What is the diagnosis? Answer: refer to page 153

Extended spectrum B-lactamase producting klebsiella pneumoniae as a cause of neonatal infection in Al Galaa Teaching Hospital

Neonatal sepsis remains to have a major impact on morbidity and mortality in neonates, Klebsilla spp. has emerged as an important cause of hospital acquired infections especially among neonates in NICU. ESBL producing Kiebsilla pneumoniae has been frequently implicated in NICU showing increase rate of mortality and morbidity because of resistance to numerous antimicrobial agents. To evaluate the piesence and frequency of ESBL Klebsilla pneumoniae in different neonatal cultures and its frequency we screened 160 newborns, both term and preterm, all selected cases had two or more clinical signs of sepsis in addition to one or more positive sepsis screen laboratory results. Blood culture was done on Biphasic media followed by subculture and biochemical identification for Kl. Pneumoniae, all isolates are subjected for antibiotics sensitivity and double disc test to detect ESBL producers. The 160 cases included 116 [72.5%] premature [<36 weeks] and 44 full term [27.5%]. From 160 cases included in the study no growth was reported in blood cultures of 42 cases [26.25%]. From the 118 [73.75%] positive blood culture cases, 72 cases were gram negative organisms [61% of positive blood culture cases]. Klebsilla was recorded in 40 cases [33.9% of all positive blood cultures and 55.6% of gram negative organisms], 80% of them were ESBL producers. All the isolates were sensitive to imipenem and meropenem and were almost always resistant to ampicillin, ticracillin and piperacillin in addition to third generation cephalosporines and monobactams. Mortality were high in ESBL producers klebsilla infection [47% of premature] and [33.3% of full terms]. In conclusion, routine detection of ESBL producing Klebsilla is required to be done by reliable laboratory methods, and moreover the therapeutic strategies to control infections in NICUs must be carefully formulated

Impaired holter-derived variables of parasympathetic activity in diabetic patients with daily-life silent myocardial ischemia

To evaluate Holter-derived variables of impaired parasympathetic activity in diabetic patients with silent myocardial ischemia. Cross sectional nature cohort study. Department of Medicine, Farwania Hospital, Kuwait. One hundred and sixty patients with diabetes mellitus. 24-hour Holter electrocardiography [ECG] monitoring was used for heart rate variability and silent myocardial ischemia. Predictive indices revealed that Holter derived variables of parasympathetic activity [p-NN50, rMMD, SDANN-i] are considered as indicators for prediction of likelihood of daily life silent myocardial ischemia in diabetic patients. Sensitivity was 86, 85, 82%, specificity=88, 89, 81%, accuracy = 87, 86, 87%, positive predictive value = 89, 90, 86% and negative predictive value = 84, 83, 81% respectively. Multivariate analysis revealed that duration of diabetes status and serum level of HbA1c, as independent variables were associated with likelihood of daily life silent myocardial ischemia [p < 0.05]. Receiver operating characteristic [ROC] curve data revealed that the best cut-off value of p-NN50 was 8% with sensitivity = 86% and false positive = 16%, [rMMD] = 26 msec with sensitivity = 85% and false positive =15% and [SDANN-i] = 96 msec with sensitivity = 81% and false positive = 21% for prediction of likelihood of daily life silent myocardial ischemia in diabetic patients. Silent myocardial ischemia in diabetic patients provides statistically significantly association with impaired parasympathetic activity

Sequential application of long pulsed dye/Nd-YAG lasers is a superior method for management of infantile hemangiomas

To evaluate the efficacy of sequential application of long Pulsed dye/Nd-YAG lasers in the management of skin and mucous membrane infantile hemangiomas. Management of infantile hemangiomas may be a challenge. Different laser systems have been reported to be of great help for such cases with variable results. In this study we present a unique sequential laser system which deliver pulsed dye laser PDL 595nm followed by Nd-YAG 1064nm to be superior than other reported techniques. Twenty five cases of infantile hemangiomas in the head and neck region were selected to he enrolled in this study. Assessment for progress was achieved clinically. We achieved excellent results in eighteen patients [72%] out of the treated 25 patients, with no recurrence after 6 months follow-up. Laser application from skin and mucous membrane sides [sandwich technique] decreased number of sessions. The sequential PDL followed by Nd-YAG laser can be considered as one of the superior methods for management of infantile hemangiomas specially in the head and neck region, due to its excellent cosmetic results with fewer number of treatment sessions

External non-invasive cardiac pacemaker: evaluation of usefulness, function and capture failure rate

To evaluate the clinical usefulness, safety and efficacy of the non-invasive temporary pacemaker [NTP]. Cohort observational study Settings: Department of Medicine, Farwania and Sabah Hospitals, Kuwait. One hundred and forty patients who presented with asystolic cardiac arrest and symptomatic bradyarrythmias Interventions: Application of a NTP that functions as VVI demand pacemaker with separate external pacing and sensing electrodes. Evaluation of pacemaker capture done by palpating carotid artery pulse, non-invasive blood pressure recording and transthoracic echocardiography. Out of 140 patients, only 76 patients responded well to NTP. Predictive indices revealed that dilated cardiomyopathy is considered as negative predictor for the failure of NTP to capture the ventricle. Sensitivity was 73%, specificity = 90%, accuracy = 78%, positive predictive value = 95% and negative predictive value = 59% respectively. Multivariate analysis revealed that chronic obstructive pulmonary disease [COPD] status, left ventricular ejection fraction [LVEF], serum potassium, chest size and left ventricular end diastolic dimension [LVEDD] as independent variables were negative predictors for failure of NTP to capture the ventricle [p < 0.05]. Receiver operating characteristic [ROC] curve data revealed that the best cut-off value for serum potassium was 3.0 mmol/1 with a sensitivity = 77% and false positive - 24%, LVEF - 15% with sensitivity = 84% and false positive = 19% and LVEDD = 7.6 cm with sensitivity = 74% and false positive = 28% to predict the failure of NTP to capture the ventricle. Transcutaneous pacemaker appears to offer benefit and may become an important tool in the management of patients with symptomatic bradycardia and asystolic cardiac arrest

Use of prophylactic antibiotics in clean surgical operations: a clinical trail in Ibn-Sina Teaching Hospital in Mukalla, Yemen

This is a randomized controlled clinical trial carried out to assess the necessity of the use of prophylactic antibiotics for clean surgical operations in the surgical wards of Ibn-Sina teaching hospital during the period from December 2002 to April 2003. A total of 80 patients with clean surgical operations and eligible for the study were randomly allocated to either treatment or control group [40 patients in each group]. Only 7.5% of patients who were not given antibiotics postoperatively developed wound infection while none of the control group, without statistical significance [P>0.05]. Neither age nor sex have statistical significant association [P>0.05]. All the surgical wound infections were observed in patients were operated for inguinal hernia. The study concluded that use of postoperative prophylactic antibiotic is not necessary for wound healing in case of clean surgical operations except for hernia operations

Non invasive evaluation of left ventricular filling pressure by doppler echocardiography

This study was carried out on 45 patients to evaluate the accuracy of different echo-Doppler parameters for the assessment of LV diastolic function. The patients were divided according to end diastolic pressure [EDP] into two groups. Comparing patients with normal and elevated EDP revealed that the deceleration time of E wave, velocity time integrity [VTI] of E-wave, acceleration slope of A wave, deceleration slope of A wave LA diameter and FS were significant variables. When taking FS into consideration, the echo-Doppler parameters were significantly valuable in the differentiation between patients with normal and elevated EDP

Ruptura bilateral simultânea do tendäo tricipital em paciente renal crônico em hemodiálise / Simutaneous bilateral rupture of the triceps tendon in a patient in hemodialysis for chronic renal failure

Os autores relatam o caso de uma paciente com insuficiência renal crônica em hemodiálise que apresentou ruptura bilateral simultânea do tendao tricipital, sendo submetida a tratamento cirúrgico, com recuperaçao dos movimentos ativos após três meses.

Detection of intrapulmonary vascular dilatations [IPVD] in patients with chronic liver disease by contrast-enhanced echocardiography using indocyanine green dye VS. isotonic saline

Intrapulmonary vascular dilatations [IPVD] are extrahepatic complications of acute and chronic liver disorders that can result in severe hypoxemia. Contrast-enhanced [CE] echocardiography provides a noninvasive method to detect right-to- left shunting associated with IPVD. We studied 23 patients with chronic liver disease to determine the prevalence of positive CE echocardiography suggesting the presence of IPVD and its relationship to arterial blood gases. None of our patients had schistosomal cor pulmonale. Five [21.7 percent] of.23 patients were hypoxemic [PaO 2<70mm Hg]. Eighteen patients [79.3 percent] had PaO 2>70mm Hg. Positive CE echocardiograms suggesting IPVD were found in 6 [26.08 percent] of 23. Three [16.7 percent] of the 18 patients with PaO 2>7Omm Hg had positive CE echocardiograms. Three [60 percent] of the five hypoxemic patients had positive CE echocardiograms. Patients with positive CE echocardiograms using indocyanine green [ICG] dye solution as a contrast were the same patients who had positive CE echocardiograms using isotonic saline solution alone as a contrast. No significant difference in the mean value of PaO 2 was noted between patients with positive and negative CE echocardiograms. We conclude that for our group of patients with chronic liver diseases, [1] IPVD as suggested by CE echo-cardiography were common [26.08 percent], [2] positive CE echocardiography could be documented in patients who were not hypoxemic [16.7 percent], [3] isotonic saline solution alone can be used as a reliable and cheap alternative for ICG dye solution in CE echocardiographic studies, [4] the presence of positive correlation between IPVD and spider naevi and esophageal varices, and [5] the absence of correlation between the Child's classification of liver dysfunction and the presence of IPVD