RESUMO
Brucellosis with different pictures is common in our country and should be noticed in high risk patients. A 23 years old male farmer, presented with headache, vomiting, and tremor. Disease had begun 6 months ago with right side orchitis, fever, chills, then, gradually illness, weakness, tremor, anorexia, vomiting, nonproductive cough, retrosternal pain and dysphagia, blurred vision, generalized muscular rigidity and disability in daily activities were added. In physical exam illness, weakness, fever, wet skin, tremor, generalized muscular rigidity, papillary edema were detected. He had positive Wright test [1/1250] and lymphocytic pleocytosis in CSF. Three drug regimen and steroid [1 month] were administered and he responded well to this initial therapy, however, during his 3[rd] month follow up, he developed severe bilateral hearing loss unresponsive to steroids and 6 months later he had a self-limiting 20 hours left sided hemiparesis. Neurobrucellosis may present with parkinsonism [tremor and generalized muscular rigidity] and meningovascular involvement. This may even progress under 3 antibiotic regimen treatment
RESUMO
Although recombinant hepatitis B vaccine is effective in a majority of population, a significant percent may do not respond [up to 10%]. Old age, obesity, heavy smoking and immunologic impairment have been associated with lower anti -HBs responses. In the present study, the efficacy of vaccine and effects of the abovementioned factors have been evaluated. Of 111 health care workers in Boo-Ali hospital, 72 participants completed primary vaccination series and antibody tittering. They received 20 micro g of recombinant HBV vaccine [Heberbiovac, Cuba] in standard schedule. Anti-HBs was determined by ELISA test [Diakey, South Korea] one month following the third dose. The lowest completion rate was reported among nursing staff and physicians [17%]. Seroprotection [anti-HBs >/= 10IU/L] was achieved in 86.1% of participants. Among seroprotected individuals, 52.8% were low-responders [anti -HBs titer of 10-99IU/L] and 33.3% were good responders [anti-HBs titer of >100IU/L]. The independent predictors of responsiveness were age less than 40 [OR=3.5, 95%CI=1.8-14.6, p<0.05], non-smoking status [OR=2.9, 95%CI=1.5- 17,2, p<0.05], and body mass index less than 25kg/m[2] [OR=4.3, 95%CI=l.9-18.0, p<0.05]. Of 10 non-responders, 7 received booster dose while anti-HBs titer was determined only in one. The primary factors associated with completion of immunization may not be amenable to job-education level. Non-compliance among non-responders was quite high [90%]. This situation seems to be grim for health care workers and warranted appropriate interventions