Complete reconstruction of osteomyelitis-induced bone degeneration using ANGIPARS in diabetic foot ulcer

Diabetic foot ulcers are one of the main health problems in diabetic patients. Nowadays, there are several ways for the treatment of diabetic foot ulcers, but some patients with bone destruction are still forced to amputation. Here, we report a rare case of complete reconstruction of osteomyelitis-induced bone degeneration using ANGIPARS in diabetic foot ulcer. A 59-year-old man with a history of type 2 diabetes mellitus presents to Kashan Shahid-Beheshti hospital, Iran, with a diabetic foot ulcer [3cm x 2cm] in his right thumb. Foot X-ray revealed complete resorption of the distal phalanx. The patient received parenteral broad-spectrum antibiotics including mercpenem. vancomycin and ciprcfloxacin, with a diagnosis of osteomyelitis. He was discharged after one month with oral antibiotics and topical and oral ANGIPARS. After 2 months follow-up, complete osteogenesis was seen in serial radiographs. In addition to healing the diabetic foot ulcer, ANGIPARS can also cause to reconstruct the degenerated bone and prevent debility due to limb amputation. Thus, the oral and topical application of ANGIPARS in the treatment of diabetic foot ulcer is recommended and more research is needed to reveal the benefits of ANGIPARS

[ case report of HIN1 pneumonia in a patient with systemic lupus erythematosus]

Infections are one of the leading causes of morbidity and mortality in systemic lupus erythematosus [SLE] patients. The immunosuppressed patients might be at risk for serious influenza-associated complications. In this case report, a man with severe novel H1N1 pneumonia with no mortality and a good prognosis is introduced. A 37-year-old man with a medical history of SLE, antiphospholipid syndrome, cerebrovascular accident and recurrent deep venous thrombosis presented with complaints of the rapid progressive fever, severe dyspnea, productive cough and progressive hemoptesis admitted to Kashan Shahid-Beheshti hospital in November 2009. The chest x-ray revealed a bilateral alveolar infiltration. Based on epidemiological evidence among some hospitalized patients compatible with H1N1 influenza as well as their unresponsiveness to antibiotic therapy, a nasopharyngeal specimen was obtained for RT-PCR and treatment with broad-spectrum antimicrobial agents and Oseltamivir was started. After 4 days of antiviral treatment, fever was removed and dyspnea was decreased. Moreover, RT-PCR was positive for H1N1 and after 10 days the patient was discharged with a good condition. According to the results, prompt diagnosis and treatment of H1N1 pneumonia in an immunosuppressed condition can prevent the morbidity and mortality of disease

[Epidemiological survey of confirmed influenza A [H1N1] in Kashan, Aran and Bidgol cities during 2009-10]

The first outbreak of Influenza A [H1N1], the first pandemic influenza in the present century, in Iran was in Kashan in July 2009. This study was carried out to describe the stages of spread and also the outcome of influenza A [H1N1] in terms of incidence and death in Kashan, Aran and Bidgol cities during 2009-10. In this case series-study of confirmed influenza A [H1N1], clinical and demographic data of all confirmed cases were recorded using SPSS software and were analyzed by Mann-Whitney test. The total number of confirmed cases [mean and median of age were 29.8 +/- 18.7 and 26 years, respectively] was 86 with a male/female ratio of 1:1. Among the 7 cases who died [mortality rate: 8.1%] the mean age for death was 46.9 +/- 27.9 years, though greater than that of the recovered cases [30.01 +/- 18.1 years], but non-significant statistically. Beginning of new educational year for schools was identified as the most important factor in spread of the disease. Considering the mortality rate and other related variables, no significant difference was seen between Kashan, Aran and Bidgol cities compared to other countries. However, comparing the present findings with the findings of other domestic medical universities can disclose the reasons for disparities. Moreover, a 10 week time interval between the first outbreak and the peak for pandemy highlights the presence of an efficient surveillance system for disease control

[Cutaneous tuberculosis presented by chest wall fistula formation]

Tuberculosis is one of the world's most debilitating diseases and it is at the top of six most prevalent and dangerous infectious diseases recognized by World Health Organization. Although one out of every three people in the world is affected by Mycobacterium tuberculosis, cutaneous infection is a relatively uncommon event. Here, we report a rare form of cutaneous tuberculosis presented by multiple fistulas over the anterior chest wall. This is a 50 year old insulin-dependent diabetic man from Afghanistan who was presented with a history of multiple skin lesions over his anterior chest wall for 3 months duration. At first, there was a single non-painful, small popular lesion, which became fistulized and developed purulent discharge, later. The patient was suspected as a case of cutaneous tuberculosis according to his nationality and prolonged history of unresponsiveness to outpatient antimicrobial treatment. This diagnosis approved based on skin biopsy result as it revealed multiple granulomas consisted of giant Langhans cells and the detection of numerous acid fast bacilli in the Ziehl-Neelsen staining of the skin secretions. Six weeks after treatment with anti-tuberculosis drugs, the signs of improvement were appeared and 6 months later there was no active fistula any more. Cutaneous tuberculosis may present itself in uncommon forms such as fistula. It might be seen anywhere including chest wall. Therefore, this impression should be considered in patients with prolonged skin lesions and featured by fistula formation