Effect of lidocaine 2% on bacterial culture of bronchial fluid

Objective: To evaluate the action of 2% lidocaine on the culture results of bronchial fluid in patients suspected of having lower respiratory tract infections

Study Design: Cross-sectional analytical study

Place and Duration of Study: Shahid Sadoughi Hospital, Yazd, Iran, from November 2014 to November 2015

Methodology: Patients suspected of lower respiratory tract infections referred to bronchoscopy unit of the Hospital were included. Those with incomplete questionnaire and bronchoscopy contraindication were excluded. Bronchial fluid was aspirated before and after local application of 2% lidocaine and cultured, according to the suspected clinical diagnosis. Finally, statistical analysis was performed using SPSS software, version 17.0. For statistical comparisons, McNemar's test was used. Level of significance was kept at p <0.05

Results: The mean age of the study population was 51.83 +/- 15.93 with a range of 25 - 80 years. Out of 130 patients, 60 patients had positive culture results. Nineteen [31.7%] cases had positive culture for tuberculosis and 41 [63.3%] cases had positive results for other bacteria before intervention that did not change after using 2% lidocaine [p=1]. In 70 [53.84%] cases, results were negative before and after use of 2% lidocaine

Conclusion: No significant difference was found between culture results before and after the use of lidocaine. Therefore, lidocaine can be used during bronchoscopy to increase patient tolerance

Computer and Internet use among Undergraduate Medical Students in Iran

Objective: Although computer technologies are now widely used in medicine, little is known about its use among medical students in Iran

The aim of this study was to determine the competence and access to computer and internet among the medical students

Methods: In this descriptive study, medical students of Shahid Sadoughi University of Medical Science, Yazd, Iran from the fifth years were asked to answer a questionnaire during a time-tabled lecture slot

The chi-square test was used to compare the frequency of computer and internet use between the two genders, and the level of statistical significance for all test was set at 0.05

Results: All the students have a personal computer and internet access

There were no statistically significant differences between men and women for the computer and internet access, use wireless device to access internet, having laptop and e-mail address and the difficulties encountered using internet

The main reason for less utilization of internet was slow speed of data transfer

Conclusions: Because of the wide range of computer skills and internet information among medical students in our institution, a single computer and internet course for all students would not be useful nor would it be accepted

[Rheumatic fever]

RF and RHD continue to be major problems in developing countries, resulting in significant morbidity and mortality. Approximately 3% [during streptococcal epidemics] and 0.3% [during nonepidemic] of individuals who have not had RF will develop the illness following an untreated streptococcal pharyngitis. Pathogenesis of RF is still not completely understood. Epidemiology of RF is similar to streptococcal pharyngitis and the most common age is 5 to 15 years. Pathogenesis of RF is likely related to an abnormal immune response to a preceding GAS infection; both humoral and cell-mediated immune responses contribute to the clinical manifestations, including acute carditis and chronic RHD. The most common clinical manifestations of RF are arthritis, carditis, and chorea; carditis and subsequent RHD are responsible for long-term morbidity and mortality. Diagnostic criteria should serve as guidelines to assist in the diagnosis of RF. Valvular dysfunction [rather than myocarditis or pericarditis] is the most important abnormality in both acute rheumatic carditis and chronic RHD. Echocardiography should be performed in all patients with RF to confirm and quantify valvular regurgitation, differentiating acute RHD from innocent murmurs or congenital heart disease, serial evaluation of patients with known RHD, and for identifying subclinical rheumatic cardiac involvement. The most important factors influencing the likelihood and severity of chronic RHD are the severity of the initial carditis and RF recurrences. Primary prophylaxis [treatment of GAS pharyngitis] is effective in preventing RF, but many cases go untreated [very mild symptoms or subclinical]. The most effective way to decrease the burden of RF and RHD in developing countries may be via development of an effective vaccine against GAS [primordial prophylaxis]. Percutaneous balloon valvotomy is effective in rheumatic mitral stenosis, mitral and aortic valve repair [instead of replacement] are becoming more prevalent

Using the internet among dental students in Yazd

Internet is an important source of up-to-date dental information for delivering educational materials. The aim of this study was to determine the use of internet among dental students in Yazd. In this descriptive study, a questionnaire consisting of multiple choice questions was distributed to clinical undergraduate students studying at the School of Dentistry at the Shahid Sadoughi University of Yazd, Iran in 2009. The chi-square test was used to compare the frequency of internet use between the two genders. The level of statistical significance for all tests was set at 0.05. Seventy-nine percent of the students used the internet in various frequencies. In general, female students used the internet more often than their male counterparts [P < 0.0001]. Although 13.79 percent of students used the internet to retrieve general information, dental topics were searched in the internet more frequently. The texts were the most commonly accessed materials [73.9 percent]. Clinical photographs were accessed by 47.9 percent and radiographic and histopathologic materials by 12.3 and 10.9 percent of the students, respectively. Our students stated that they could find required information on dental subjects in english sites [96.6 percent] much more frequently than in the farsi sites [78 percent]. The results of this study reflect the attitudes of dental students to internet use as a part of their education in Shahid Sadoughi University of Yazd

Post BCG lymphadenitis in vaccinated infants in Yazd, Iran

Bacille Calmette-Gu?erin [BCG] vacination is performed as a part of expanded program of immunization [EPI].Lymphadenitis is the most common complication of BCG vaccination. The aim of this study was to determine the incidence and natural course of BCG lymphadenitis vaccinated in Yazd, Iran. In this analytical prospective follow up study a total of 480 [240 females and 240 males] consecutive newborns received 0.05 ml of BCG vaccine intradermally on right arm within the first week of life during April to July 2003. These babies were followed up when 1.5, 3, 4.5, 6 and 9 months old. A total of 26 [5.8%] cases of lymphadenitis were detected. Lymphadenitis occurred as ipsilateral axillary nodes in 24 [92.3%] cases, supraclavicular in one [3.8%] case, and supraclavicular in association with axillary nodes in one case [3.8%]. Infants developed lymphadenitis during 4 wks of life in one [3.84%] case, between first and fourth month of life in 14 [53.8%] cases, and between fourth and sixth month of life in 11 [42.3%] cases. All 26 cases of lymphadenitis were followed up for 9 months. Twenty two [84.6%] cases were simple or non-suppurative and 4 [15.4%] cases suppurative lymphadenitis. Eleven [42.3%] cases of non-suppurative lymphadennitis showed spontanous resolution and eleven [42.3%] cases had partial regression without progression or drainage. Four [15.4%] cases developed suppuration with one [3.8%] case of fistulation and drainage. The greater incidence of lymphadenopathy in our cases can probably be attributed to a more immunogenic vaccine [Pasteur institute, Tehran], young vaccinees [newborn infants], injection in the right arm or improper dilution. Non-suppurative BCG lymphadenitis is a benign condition and regresses spontanously without any treatment

Prolonged fever occurring during treatment of pulmonary tuberculosis

Fever occurs in 60-85% of patients afflicted with tuberculosis. Fever usually resolves by the second week of starting chemotherapy. However, there are patients who remain febrile beyond a reasonable period of time or develop fever during treatment. This study has been carried out to investigate the causes of fever in such patients. The study was carried out in an infectious and tropical center [Yazd, Iran]. Only fresh sputum positive cases were eligible for entry into the study, if they remained febrile for more than 2 weeks after starting chemotherapy or if they developed fever for 7 days while on treatment. A total of 31 patients with ages ranging between 29 and 70 years [mean 47 years] were studied. There were 13 [41.93%] patients who had evidence of extra-pulmonary disease; these included spondylitis in 6, arthritis of hip in 3, genitourinary in 2, and cold abscess in 2 patients. Other causes of fever included drug reaction, malaria, and malignancy. In 8 cases, no cause other than of pulmonary tuberculosis could be found and the fever resolved gradually. This study shows that fevers developing or persisting in patients undergoing treatment for pulmonary tuberculosis require careful, repeated clinical examination and detailed investigations and should not be attributed to treatment non- adherence or the emergence of drug resistance. Locally prevalent associated diseases should be ruled out at first. Liberal use of ultrasound and CT Scan should be made to detect pus collections in the pleura, chest wall and other organs

Typhoid fever complicated by leukocytoclastic vasculitis

We report a case of typhoid fryer with an unusual presentation: prolonged fever with painful purpuric skin lesions of the legs, splenic abscess and pancreatitis, The diagnosis was made upon isolation of S. typhi in blood cultures, and ruling out other causes of leukocytoclastic vasculitis. The outcome was favorable with antibiotics alone without surgery

Measurement of tuberculin skin test

Current guidelines suggest that the PPD Mantoux tuberculin test should be read after 48 or 72 hours. We have compared the measurements at these time points. A 5-tuberculin unit [TU] PPD Mantoux test was administered to 100 subjects [91% with Bacillus Calmette- Guerin scars]. Induration was measured 48 and 72 hours following the injection. The measurements made at 72nd hour were significantly higher than those made at 48th hour [median: 8.9 vs 4.5mm, p=0.01]. In those subjects with indurations at either or both time points [n=74], the readings taken at 72nd hour were on average 2.1mm [95% confidence interval: 0.3-3.1mm] larger than those at 48th hour. Using an induration of >15mm diameter to define a positive result, there were more positive test results at 72nd hour [24] compared to 48th hour [20]. We concluded that, in adults, the size of the 5-TU Mantoux reaction is significantly larger at 72nd hour, thus, in clinical practice, tuberculin tests should be read at this time point since negative tests at 48th hour may be false negative

Epidemiological, clinical, diagnostic and therapeutic survey in 686 cases with brucellosis

The current study was conducted to examine the epidemiology, clinical and hematological characteristics, complications and treatment outcome of brucellosis in Yazd [Iran].A total of 686 cases [390 males] were recorded in which the diagnosis was confirmed by a positive culture or detection of antibodies with STA test. About 40% of these patients came from families of farmers or shepherds who owned a few domestic animals or small herds of goats or sheepsand 68.7% had consumed unpasteurized dairy products especially cheese. In 27% of the cases another family member developed symptomatic infection. Most of the patients presented with musculoskeletal symptoms [86.5%], headache and vertigo [67.3%]. Lymphadenitis was recorded in 27%, splenomegaly was recorded in 20% and hepatomegaly in 5% of the cases.Normal CBC [77%] and anemia [12%] were the most common hematological manifestations, followed by lymphocytosis [12%].None of the patients who received a combination of two antibiotics for at least 8 weeks had relapse

Brucellosis with Acute Acalculous Cholecystitis

Acute acalculous cholecystitis has been associated, although rarely, with brucellosis. We have recently encountered a 45-year-old previously healthy man with brucellosis who presented with abdominal pain from cholecystitis

Night Sweats

Although night sweating is a common outpatient complaint, medical literature on this subject is scarce. Tuberculosis, brucellosis and lymphoma are diseases in which night sweating is a dominant symptom, but these are infrequently found to be the cause of night sweats in modem practice. While these diseases remain important diagnostic considerations in patients with night sweats, other diagnoses to consider include human immunodeficiency virsus infection, gastroesophageal reflux disease, obstructive sleep apnea, hyperthyroidism, hypoglycemia, and several less common diseases. Antihypertensives, antipyretics, and other medications such as drugs of abuse including alcohol and heroin may cause night sweats. Serious causes of night sweats can be excluded with a thorough history taking, physical examination, and appropriate laboratory and imaging studies

Descriptive study of herpes zoster in patients referred to the infectious and tropical diseases clinic of Yazd between 1999-2004

Shingles, also known as herpes zoster, results from the reactivation of the varicella-zoster virus [VZV] within the peripheral nerves and their relevent dermatomes, usually decades after recovery from chickenpox, the primary infection with VZV. In this cross-sectional study all patients with herpes zoster disease referred to the infectious and tropical diseases clinic of Yazd in a 6-year-period between 1999 and 2004 were reviewed. One hundred nine patients were reviewed. The disease was most prevalent in patients from 61 to 70 years of age [28.4%], and 52.23% of them were male. The most commonly involved regions were thoracic [49%], followed by cervical [25.0%], lumbosacral [21%] and trigeminal [12%] dermatomes. Herpes zoster was most frequently observed in summer and the lowest frequency was in spring. Bilateral involvement was observed in 3% of cases. The results of current study is similar to other Iranian and foreign studies. The disease was more frequently observed in the elderly people. It affects both genders and both sides of the body with similar frequency. The most commonly involved dermatome was thoracic