Mechanical evaluation of the effect of the rod to rod distance on the stiffness of uniplanar external fixator frames.

PURPOSE: To investigate the effect of the rod-to-rod distance on the mechanical stability of single-rod and double-rod external fixator frames. METHODS:  Four different constructs, one single-rod and three double-rod constructs with different rod-rod distances, were subjected to the axial, bending, and torsional forces. The stiffness of different configurations was calculated. RESULTS:  Single-rod configuration had statistically the lowest stiffness when subjected to the axial, bending, and torsional forces. Maximum stiffness against the axial and anterior-posterior bending forces was achieved when the rod-rod distance was adjusted to 50 mm (halfway between the first rod and the end of the Schanz pins). There was no statistically significant difference in lateral bending stiffness among different double-rod configurations (p value: 0.435). The maximum stiffness against torsional forces was achieved when the rod-rod distance was adjusted to 100 mm (the second rod at the end of the Schanz pins). CONCLUSION:  Double-rod uniplanar external fixator frames are significantly stiffer than the single-rod constructs, and however, the rod-rod distance can significantly affect the construct stiffness. We found that a frame with 50 mm rod-rod distance was the optimum fixator among tested configurations that allowed a balance between axial, bending, and torsional stiffness of the construct.

Factors increasing mortality of the elderly following hip fracture surgery: role of body mass index, age, and smoking.

OBJECTIVES: Hip fracture is one of the most common public health problems with a significant financial burden on the patient and on the healthcare system. This study was conducted to assess the 3-month and 1-year mortality rates of patients with operated hip fractures and to determine the influence of predictors of mortality. METHODS: In this prospective cross-sectional study, all admitted patients aged more than 50 years with hip fracture at Chamran Hospital from January 2008 to August 2013 were enrolled. The characteristic data obtained included demographic information, body mass index (BMI), smoking, any previous history of osteoporotic fracture, and comorbidities. In addition, the mechanism of fracture, fracture type, and treatment method were recorded. A follow-up with the patients was conducted at 3 months and 1 year through a telephonic interview to ask about possible mortalities. Statistical analyses were performed using SPSS software version 17.0 for Windows. RESULTS: A total of 1015 patients aged 50 years and older with hip fracture underwent surgery. Only 724 patients (71.3 %) completed the survey and the 1-year follow-up interview. The mean age was 75.7 ± 10.6 years. Overall, the 3-month and 1-year mortality rates were 14.5 and 22.4 %, respectively. Multivariate logistic regression analysis recognized age (OR 1.08; 95 % CI 1.05, 1.11, p < 0.001), BMI (OR 0.88; 95 % CI 0.82, 0.96, p = 0.003), and smoking (OR 1.76; 95 % CI 1.05, 2.96, p = 0.03) as major independent risk factors for mortality. CONCLUSION: It is clear that modifiable factors like quitting the habit of smoking and gaining more energy with better nutrition could reduce the mortality rate if hip fracture occurs in the elderly.

A potential role for cytomegalovirus in a facial ulcer in a renal transplant recipient.

Cytomegalovirus infection (CMV) is a well-known consequence of immunosuppression and one of the expected pathogens in recipients of solid organs such as renal transplant recipients (RTRs). Infection by CMV in immunocompromised settings can be life-threatening since many organs are involved and affected. Skin involvement has been rarely reported. In this report, we present a highly immunosuppressed RTR with CMV infection manifested as ulcerative skin lesions on the face, along with allograft dysfunction diagnosed by biopsy of the skin and the renal allograft, in addition to the presence of viral DNA in the tissue and antigenemia, which resolved following antiviral treatment. To the best of our knowledge, this is the first report in the literature of facial skin involvement induced by CMV in an RTR. This report emphasizes the value of early biopsy in RTRs with skin lesions and highlights CMV infection as a possible etiology.

Results of fusion and instrumentation of thoracic and lumbar vertebral fractures in children: a prospective ten-year study.

BACKGROUND: Researches on the results of surgical treatment of thoracolumbar spine fractures are infrequent. The aim of this study was to determine midterm outcomes of surgical treatment of these fractures in a prospective survey. METHODS: A case series study on pediatric patients with the diagnosis of thoracic and/or lumbar vertebral fractures was conducted over a ten-year period. Surgically treated patients were evaluated in the follow-up period, based on back pain, independent function, neurological status, and radiographic indices. RESULTS: There were 102 pediatric individuals, 61 boys and 41 girls, aged 3-17 years (mean 12 years of age) with thoracic and/or lumbar spinal fractures. Motor vehicle accident was the most common mechanism of injury (45.0 %). L1 was the most frequent level of fractured vertebra (24.4 %), and pelvic fracture was the most common associated orthopedic injury (21.5 %). Totally, 20 patients underwent surgery, but only fifteen (14 boys and one girl) participated in follow-up (mean 49 months; range 12-81 months). Posterior spinal fusion and instrumentation was accomplished in 12 cases. Three patients were operated by anterior approach and fusion followed by posterior fusion and instrumentation because of delay in diagnosis. There were no major perioperative complications. Two cauda equina syndromes and two incomplete spinal cord injuries improved back to normal. Five cases (33.3 %) reported occasional back pain, and all patients were functionally independent. Radiographic indices improved significantly. CONCLUSIONS: Spinal fusion and instrumentation in pediatric patients with unstable thoracolumbar vertebral fractures with or without spinal cord injuries have favorable radiographic and functional outcomes.

Vancomycin-Resistant Entrococci colonization in chronic hemodialysis patients and its risk factors in southern Iran (2005-2006).

BACKGROUND: Vancomycin-resistant enterococci (VRE) recently have emerged as a nosocomial pathogen among dialysis patients. This study aims to appraise the prevalence, incidence density and risk factors for VRE colonization among these patients. METHODS: In this prospective study, 782 stool or rectal swab specimens were collected from 250 chronic hemodialysis patients with an interval of at least one month. To identify the risk factors of VRE colonization, demographic and health data of VRE+ and VRE- patients were compared. RESULTS: VRE colonization was detected in 55 (22%) patients during study. Incidence density of one case per 79.6 patient-month of follow up was estimated.The only significant difference between the data collected from VRE+ and VRE- patients was observed in antibiotic consumption (P<0.001). CONCLUSION: VRE colonization is relatively high and rapidly spreading among chronic dialysis patients. It is strongly associated with recently antibiotic consumption.

CSF levels of cytokines in neuro-Behçet's disease.

BACKGROUND: Neurological manifestations of Behçet's disease (neuro-Behçet's disease) present in 5-30% of patients. Although cytokines play a pivotal role in pathogenesis of Behçet's disease, published studies about the cerebrospinal fluid (CSF) levels of cytokines in neuro-Behçet's disease are scanty. METHODS: Nine patients with active parenchymal, one patient with non-parenchymal neuro-Behçet's disease, six patients with headache attributed to Behçet's disease, 13 patients with viral meningitis, and 19 healthy controls were recruited. Interleukin 6, 8, 10, tumor necrotic factor-alpha, and interferon-gamma were measured in the CSF using enzyme-linked immunosorbent assay method. RESULTS: Patients with viral meningitis had significantly higher levels of all investigated cytokines except for interferon-gamma in comparison with the patients with parenchymal neuro-Behçet's disease, headache attributed to Behçet's disease and controls (P values <0.05). CSF interleukin 6 was significantly higher in patients with parenchymal neuro-Behçet's disease in comparison with the controls (P=0.025). CSF levels of investigated cytokines had no significant difference between patients with headache attributed to Behçet's disease and controls (P values >0.05). Patients with headache attributed to BD and patients with parenchymal NBD had no significant difference in measured cytokines (P values >0.05). CONCLUSION: In contrast to some previous studies, our investigation showed loss of analogy between CSF cytokine profiles of patients with parenchymal neuro-Behçet's disease and viral meningitis. Also we postulated a crucial role for interleukin 6 in immunopathogenesis of neuro-Behçet's disease.

Meningococcal carrier rate before and after hajj pilgrimage: effect of single dose ciprofloxacin on carriage.

We determined the carriage rate of Neisseria meningitidis before and after hajj pilgrimage among a group (1) of 674 randomly selected Iranian pilgrims, and the effect of 500 mg of ciprofloxacin given 24 hours before return on the reduction of meningococcal carriers among another group (2) of 123 randomly selected Iranian pilgrims. Throat specimens taken 1 hour before departure on the hajj and immediately on return were cultured. Carriage rates of N. meningitidis in group 1 were 5.2% before and 4.6% after pilgrimage (P = 0.65); 3 new serogroups (Z, Z and A) were identified on return. In group 2, the carriage rate decreased from 8.1% to zero before and after pilgrimage.

Meningococcal carrier rate before and after hajj pilgrimage: effect of single dose ciprofloxacin on carriage

We determined the carriage rate of Neisseria meningitidis before and after hajj pilgrimage among a group [1] of 674 randomly selected Iranian pilgrims, and the effect of 500 mg of ciprofloxacin given 24 hours before return on the reduction of meningococcal carriers among another group [2] of 123 randomly selected Iranian pilgrims. Throat specimens taken 1 hour before departure on the hajj and immediately on return were cultured. Carriage rates of N. meningitidis in group 1 were 5.2% before and 4.6% after pilgrimage [P = 0.65]; 3 new serogroups [Z, Z' and A] were identified on return. In group 2, the carriage rate decreased from 8.1% to zero before and after pilgrimage

Evaluation of rK39 strip test for the diagnosis of visceral leishmaniasis in infants.

This study estimated the sensitivity and specificity of the rK39 strip test compared with the immunofluorescent antibody test and microscopy of bone marrow aspirate smears (the gold standard) in 47 children with suspected visceral leishmaniasis. A control group of children with other diagnoses (tuberculosis, toxoplasmosis, systemic lupus erythematosus, malaria or cutaneous leishmaniasis) were also tested to check false positive results. The sensitivity and specificity of the strip test were 82.4% and 100% and that of immunofluorescent antibody were 100% and 92.7%. The rK39 strip test is reliable where there is no access to laboratory facilities.

Evaluation of rK39 strip test for the diagnosis of visceral leishmaniasis in infants

This study estimated the sensitivity and specificity of the rK39 strip test compared with the immunofluorescent antibody test and microscopy of bone marrow aspirate smears [the gold standard] in 47 children with suspected visceral leishmaniasis. A control group of children with other diagnoses [tuberculosis, toxoplasmosis, systemic lupus erythematosus, malaria or cutaneous leishmaniasis] were also tested to check false positive results. The sensitivity and specificity of the strip test were 82.4% and 100% and that of immunofluorescent antibody were 100% and 92.7%. The rK39 strip test is reliable where there is no access to laboratory facilities

Prevalence of measles antibody in children of different ages in Shiraz, Islamic Republic of Iran.

An outbreak of measles due to secondary vaccine failure prompted this investigation into the prevalence of measles antibody in children. We studied 608 children in 7 different age groups: 6, 9, 14 and 18 months and 6, 10 and 15 years. Children in the 2 youngest groups received no vaccination; the rest were vaccinated at 9 months and 15 months. The 15-year-old age group received an additional vaccination. Transplacental measles antibody (Ab) decreased from 10.0% at 6 months to 0% at 9 months. Measles Ab was positive in 52.9% (14 months), 89.4% (18 months), 60.8% 96 years), 45.0% (10 years) and 96.8% (15 years). To increase Ab levels, a booster vaccination is recommended, administered either with the second DPT booster or at pre-high school age.

Prevalence of measles antibody in children of different ages in Shiraz, Islamic Republic of Iran

An outbreak of measles due to secondary vaccine failure prompted this investigation into the prevalence of measles antibody in children. We studied 608 children in 7 different age groups: 6, 9, 14 and 18 months and 6, 10 and 15 years. Children in the 2 youngest groups received no vaccination; the rest were vaccinated at 9 months and 15 months. The 15-year-old age group received an additional vaccination. Transplacental measles antibody [Ab] decreased from 10.0% at 6 months to 0% at 9 months. Measles Ab was positive in 52.9% [14 months], 89.4% [18 months], 60.8% 96 years], 45.0% [10 years] and 96.8% [15 years].To increase Ab levels, a booster vaccination is recommended, administered either with the second DPT booster or at pre-high school age