Leishmaniasis with Femoral Bone Involvement.

Visceral leishmaniasis is mostly subclinical, but it can become symptomatic and take acute, subacute or chronic forms. Its incubation period varies from weeks to months and can even be as long as years. Avast variety of organ involvement may be there. We report a case of osseous leishmaniasis presenting with only a long standing mild knee pain without any laboratory or organ abnormality and showed a pure bone involvement on X-ray and CTscan. Later on, it developed into a discharging sinus and the discharge showed Leishman bodies which was reconfirmed the rough bite. As the patient had reactions with amphotericin B, systemic glucantine was given which led to clinical improvement and smaller radiological lesion.

Clinical features of epilepsy at 2 referral hospitals in Northern Iran.

OBJECTIVE: To investigate the demographic and clinical characteristics of epilepsy in 2 referral hospitals in northern Iran. METHODS: In this cross-sectional study, we evaluated 300 patients with the confirmed diagnosis of epilepsy referred to the Neurology clinics of 22-Bahman, and 17-Shahrivar Hospitals, Mashad, Iran, from April 2011 to December 2012. We collected and analyzed demographic and disease information. RESULTS: The mean age of patients was 31.5+/-15.3 years. The diagnosis of disease had been made approximately 10 months after the onset of symptoms, and the treatment gap was 28%. The most widely used anticonvulsants were sodium valproate, carbamazepine, and phenobarbital. Generalized seizure was seen in 78%, partial seizure in 22%, and a combination of them in 11% of patients. Tonic-colonic seizure (72%) was the most common type of generalized epilepsy, and secondarily generalized seizure was the most frequent type of partial epilepsy. CONCLUSION: The epidemiological features of epilepsy in our region with regard to age and gender are the same as other parts of the world. The generalized type is the most common form of epilepsy, with tonic-colonic seizures being the most frequent type in our area.

Diagnostic accuracy of cone-beam computed tomography in the evaluation of chronic rhinosinusitis.

INTRODUCTION: This study assessed the agreement of cone-beam computed tomography (CBCT) scan and sinus endoscopy findings and attempted to find a diagnostic accuracy of CBCT in patients with chronic rhinosinusitis (CRS). METHODS: Forty-two patients with CRS referred to the Aria and 22 Bahman Hospitals in Mashhad, Iran, during the year 2011 were included in this cross-sectional study. Paranasal sinus CBCT scanning and endoscopy were performed in all patients. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of CBCT were determined, and the agreement between CBCT and endoscopy findings was evaluated. RESULTS: In most of our findings, except for infundibulum thickening, there was a strong agreement between CBCT and paranasal sinus endoscopy, with a kappa coefficient >0.80 (p < 0.05). The sensitivity, specificity, PPV, NPV, and accuracy of CBCT were >80% for most of the findings, except for infundibulum thickening and septal deviation. CONCLUSION: CBCT has nearly the same diagnostic accuracy as sinus endoscopy. The accuracy of CBCT scanning is high, and CBCT findings are well correlated with sinus endoscopy findings. Considering its high accuracy and lower costs and radiation doses, CBCT may be a proper alternative method for diagnostic sinus endoscopy in the assessment of CRS in patients with a contraindication for sinus endoscopy.

ISOLATED HYDATID DISEASE OF THE ILIAC BONE.

Hydatid disease of the bone usually is asymptomatic and is found as an accidental finding during unrelated imaging. However, they can become symptomatic due to enlargement and pressure effect or being infected by bacteria. Hydatid disease usually involves multiple organs (such as liver, lungs and brain). In our case, hydatid disease had involved bone and the patient presented only with a chronic hip pain without other symptom or sign. Here, a case of isolated ilium hydatidosis is reported.

Quality of life in patients who underwent rhinoplasty.

Despite developments in the therapeutic field of cosmetic surgery, there is a little information about the effects of cosmetic procedures on quality of life (QOL), especially in Iran. Rhinoplasty is the most common cosmetic surgeries. The aim of this study was to evaluate QOL and General Health before and after rhinoplasty. Patients aged 18 to 55 years seeking cosmetic rhinoplasty were included in this study. Demographic information such as age, sex, marital status, and education of patients were recorded. General Health Questionnaire (GHQ-28) and World Health Organization Quality of Life (WHOQOL-BREF) questionnaire were completed by a single investigator for all patients, before and 3 months after rhinoplasty. A total of 50 patients were enrolled in this study. Overall, 78% were women and 22% were men. QOL did not change significantly (p < 0.05) except for its psychological domain, which did not depend on sex, age, marital, and educational status. Also, general health changes after rhinoplasty was not statistically significant (p > 0.05) and it did not depend on age, sex, and marital status. It seems that cosmetic rhinoplasty has no significant effect on general health and QOL except for its psychological health domain.

The Effect of Adenotonsillectomy on Children's Quality of life.

INTRODUCTION: Adenoid hypertrophy is the most common cause of chronic airway obstruction in children. The aim of this study was to evaluate the effect of adenotonsillectomy on sleep and behavioral disorders in children with adenotonsillar hypertrophy. MATERIALS AND METHODS: In a prospective observational study, all children with an indication of adenotonsillectomy based on American Academy of Otolaryngology - Head and Neck Surgery criteria and sleep disorders referred to our otolaryngology clinic were enrolled and examined. Rutter Children's Behavior (RCBQ) and Child Sleep Habit Questionnaires (CSHQ) were completed by the children's parents both before and 3 months after the operation. RESULTS: A total of 44 children (25 boys and 19 girls) with a mean (standard deviation [SD]) age of 7.86± 2.26 years and mean (SD) body mass index (BMI) of 16.37±1.35 kg/m(2) were studied. Mean scores of RCBQ and CSHQ decreased significantly 3 months after adenotonsillectomy, and sleep habits and behavior improved significantly (P<0.05). Although there was no significant relationship between improvement of behavior and the gender, age or BMI of the children, there was a significant relationship between improvement of sleep habits and age as well as BMI (P<0.05). CONCLUSION: As adenotonsillectomy causes significant improvements in children`s quality of life (including sleep and behavior), it is recommended in children with adenotonsillar hypertrophy.

Connection between Cell Phone use, p53 Gene Expression in Different Zones of Glioblastoma Multiforme and Survival Prognoses.

The aim of this paper is to investigate p53 gene expression in the central and peripheral zones of glioblastoma multiforme using a real-time reverse transcription polymerase chain reaction (RT-PCR) technique in patients who use cell phones ≥3 hours a day and determine its relationship to clinicopathological findings and overall survival. Sixty-three patients (38 males and 25 females), diagnosed with glioblastoma multiforme (GBM), underwent tumor resection between 2008 and 2011. Patient ages ranged from 25 to 88 years, with a mean age of 55. The levels of expression of p53 in the central and peripheral zone of the GBM were quantified by RT-PCR. Data on p53 gene expression from the central and peripheral zone, the related malignancy and the clinicopatholagical findings (age, gender, tumor location and size), as well as overall survival, were analyzed. Forty-one out of 63 patients (65%) with the highest level of cell phone use (≥3 hours/day) had higher mutant type p53 expression in the peripheral zone of the glioblastoma; the difference was statistically significant (P=0.034). Results from the present study on the use of mobile phones for ≥3 hours a day show a consistent pattern of increased risk for the mutant type of p53 gene expression in the peripheral zone of the glioblastoma, and that this increase was significantly correlated with shorter overall survival time. The risk was not higher for ipsilateral exposure. We found that the mutant type of p53 gene expression in the peripheral zone of the glioblastoma was increased in 65% of patients using cell phones ≥3 hours a day.

Using a sternocleidomastoid muscle flap to prevent postoperative pharyngocutaneous fistula after total laryngectomy: a study of 88 cases.

Complications of total laryngectomy can have serious implications for the final outcome of treatment, including pharyngocutaneous fistula. We conducted a retrospective study of surgical techniques to determine how to best prevent or decrease the incidence of pharyngocutaneous fistula following total laryngectomy. We reviewed the hospital records of all patients who had undergone total laryngectomy for laryngeal carcinoma at Ghaem Hospital in Mashhad, Iran, from March 1989 through February 2005. We identified 88 such patients-80 men and 8 women. We divided this cohort into two groups according to the type of pharyngeal defect closure they received. A total of 37 patients-31 men and 6 women (mean age: 61.4 ± 5.9 yr) underwent primary closure along with a sternocleidomastoid muscle (SCMM) flap (flap group). The other 51 patients-49 men and 2 women (mean age: 61.3 ± 4.4 yr)-underwent standard primary closure without creation of an SCMM flap (nonflap group). Overall, postoperative pharyngocutaneous fistula occurred in 9 of the 88 patients (10.2%)-1 case in the flap group (2.7%) and 8 cases in the nonflap group (15.7%). The difference between the two groups was statistically significant (p < 0.001; odds ratio = 0.612, 95% confidence interval = 0.451 to 0.832), independent of other factors. We found no correlation between fistula development and age (p = 0.073), sex (p = 0.065), or tumor location (p = 0.435). Likewise, we found no correlation between tumor location and either sex (p = 0.140) or age (p = 0.241). We conclude that including an SCMM flap in the surgical process would significantly decrease the development of fistula, regardless of age, sex, and tumor site.

Association of meteorological factors and seasonality with preeclampsia: a 5-year study in northeast of Iran.

BACKGROUND: Preeclampsia is one of the common causes of maternal and fetal mortality, and an important problem of pregnancy. This disorder can cause intracranial hemorrhage, intravascular coagulation, pulmonary edema, liver and renal failures and placental abruption. OBJECTIVE: To evaluate the effects of seasonal and monthly changes of weather, humidity and temperature on the incidence rate of preeclampsia according to the conception and delivery times. MATERIALS AND METHODS: Retrospective analysis of hospital records of 20,520 consecutive singleton live birth pregnancies of 20-42 weeks of gestation during 2002-2008 was performed. After including preeclamptic cases, on the basis of American College of obstetricians and gynecologists (ACOG) criteria, gestational age and time of conception was estimated and the mean relative temperature and humidity of each month was derived from monthly climatological data collection of IRAN METEOROLOGICAL ORGANIZATION (IRIMO) between 22 June 2002 and 19 March 2008 (68 months). Statistics of each month's births were registered separately. RESULTS: Mean maternal age of 262 qualified singleton pregnant women with preeclampsia out of 20,520 deliveries were 26.48 years old and 85.9% of deliveries were done by cesarean section method. Based on time of conception, the highest prevalence was detected in summer, especially in September (11.06875%) and August (10.3053%) and the lowest prevalence was found in winter and early spring, especially in January (5.7552%) and April (5.7252%). CONCLUSION: Seasonal (monthly) variations of the weather (humidity and temperature) have a significant impression on preeclampsia prevalence.