Epidemiological features of human brucellosis in central Iran, 2006-2011.

OBJECTIVES: Brucellosis is still one of the most challenging issues for health and the economy in many developing countries such as Iran. This study investigated the epidemiological features of brucellosis in Isfahan province in central Iran. STUDY DESIGN: This retrospective descriptive study was planned to determine the epidemiological features of brucellosis in central Iran, as this is one of the most endemic areas in the country. METHODS: Data collection was performed using epidemiological questionnaires from the private and public sectors over a 4-year period (2006-2009). RESULTS: In total, 1996 cases of brucellosis were reported. The incidence of brucellosis decreased from 17.1/100,000 in 2006 to 8.2/100,000 in 2009. The male:female ratio was 2.1, and the disease was most common in individuals aged 15-20 years. Sixty-eight percent of cases were from rural areas, and the animal contact rate was 81% in rural cases and 61% in urban cases. Raw milk was the most commonly consumed dairy product, consumed by 37% of cases. CONCLUSIONS: Health-related interventions need to empower communities at risk, especially young men and adult women in the western districts of Isfahan province. Public health promotion is needed for control of risk factors in these areas.

Predictors of blood product use in orthotopic liver transplantation using the piggyback hepatectomy technique.

UNLABELLED: Orthotopic liver transplantation (OLT) has historically been associated with massive blood loss and hemodynamic instability related to the coexistence of varices, coagulopathy, thrombocytopenia, and portal hypertension. Piggyback hepatectomy (PGB) is a technique increasingly utilized in OLT to avoid veno-venous bypass and vena cava clamping. This study evaluated the factors associated with blood loss and blood product requirement in PGB. METHODS: This study is a retrospective review of the anesthesia preoperative and operative notes and computerized lab values for all adult cadaveric liver transplants over a 42-month period. These data were combined with the liver transplant database for analysis. Approximately 98% of the transplants were performed using a standard piggyback approach with no use of veno-venous bypass. RESULTS: Data were included for all 526 transplants performed during this time period. Estimated blood loss (EBL) was 1000 cc. Median transfusion requirement was 3 units packed red blood cells, 7 units fresh frozen plasma, and 6 units platelets. Multivariate linear regression demonstrated that predictors of EBL were age, MELD score, preoperative hemoglobin, initial fibrinogen, initial central venous pressure, and total anesthesia time. Predictors of PRBC useage were age, MELD score, preoperative hemoglobin, initial fibrinogen, and anesthesia time. Postoperatively increased transfusion requirement was associated with increased length of hospital stay and lower 90-day and 1-year graft and patient survivals. CONCLUSION: These results demonstrate that PGB can be safely accomplished in nearly all liver transplant patients without venovenous bypass or vena cava clamping and with less warm ischemia, which may ultimately be associated with less perioperative morbidity and improved outcomes.