Iranian Journal of Medical Sciences
Volume:35 Issue: 2, Jun 2010

Spleen is the most frequent solid organ to be injured in blunt abdominal trauma. Considering its important role in providing immunity and preventing infection by a variety of mechanisms, every attempt should be made, if possible, to salvage the traumatized spleen at any age particularly in children. After primary resuscitation, mandatory requirements for non-operative management include absence of homodynamic instability, lack of associated major organ injury, admission in the intensive care unit for high-grade splenic injury and in the ward for milder types with close monitoring. About two third of the patients would respond to non-operative management. In most patients, failure of non-operative measures usually occur within 12 hours of management. Determinant role of abdominal sonography or computed tomography, and in selected cases, diagnostic peritoneal lavage, for appropriate decision cannot be overemphasized. However, the high status of clinical judgment would not be replaced by any paraclinical investigations. When operation is unavoidable, if possible, spleen saving procedures (splenorrhaphy or partial splenectomy) should be tried. In case of total splenectomy, auto-transplantation, preferably in the omental pouch, may lead to return of immunity, at least partially, to prevent or reduce the chance of subsequent infection. Although total splenectomy with autograft is immunologically superior to total splenectomy-only procedure, these patients should also be protected by vaccination and daily antibiotic for certain period of time. The essential steps for prevention of overwhelming infection after total splenectomy are not only immunization and administration of daily antibiotic (up to 5 years of age or one year in older children), but include education and information about this dangerous complication. When non-operative management is successful, the duration of activity restriction (in weeks) is almost equal to the grade of splenic injury plus 2.

Administration of albumin for burn patients and its effects on mortality and morbidity has been debated for along time. The aim of this study was to evaluate the effects of albumin administration on wound healing, length of hospital stay, weight change, and mortality of burn patients. Two matched groups of patients from Shiraz Burn Care Center were randomly selected. The patients in one group received parenteral albumin in addition to high protein diet and the other group received only high protein diet. The length of hospital stay, healing time, mortality, serum albumin, transferrin levels, and weight loss were compared. A total of 141 patients were selected; 71 patients in control group and 70 patients in albumin group. There were no significant differences in mortality (P=0.97), length of hospital stay (P=0.45), and healing time (P=0.25) in two groups. The patients who survived had significantly higher serum transferrin level (128 mg/dL versus 102 mg/dL). Parenteral albumin administration did not have a significant effect on mortality, length of hospital stay, and healing time in burn patients.

Multidrug resistance and production of extended spectrum β-lactamases (ESBLs) by enteric gram-negative rods in hospitals and community continue to be worsened. We aimed to characterize the multidrug resistance and determine the prevalence of ESBL production by clinical isolates of Enterobacteriaceae in southeast Iran.
Gram-negative bacteria isolated from clinical samples of hospital inpatients and outpatients from three hospitals in southeast Iran were tested for susceptibility to 10 commonly used antimicrobials. For 500 isolates which showed resistance to ≥3 antibiotics from different classes, minimum inhibitory concentration, and prevalence of ESBL production were determined by agar dilution and double disc synergy method respectively. The isolated bacterial species were compared in respect of antibacterial resistance, ESBL production, patients'' gender, hospital ward, and type of specimen.
The most frequent resistance was to trimethoprim/ sulfamethoxazole, amoxicillin, and tetracycline. Imipenem with 99.8% and ceftizoxime with 83% susceptibility were the most active agents. A total of 53.8% of isolates expressed ESBL production. Escherichia coli and Klebsiella pneumoniae were most common in outpatients, and inpatients samples respectively. Higher rate of resistance to most antibacterial agents and ESBL production was found in samples of inpatients.
The present study showed high prevalence of ESBL-producing Enterobacteriaceae especially in the patients admitted to hospital. Infection control strategy with continuous resistance surveillance is essential to monitor in vitro susceptibility to antibacterial agents currently used in clinical practice. Determination of the type of involved ESBL enzymes is important for a better antimicrobial control and empirical therapy of critically ill patients in hospitals.

Blood stream infection is one of the main causes of morbidity and mortality in patients with cancer. The purpose of this study was to evaluate the prevalence of aerobic and anaerobic-bacteremia in hospital inpatients with cancer and to determine the antibiotic resistance profile in isolated organisms in Kerman, southeast Iran. Total of 240 blood cultures from 136 patients were examined. The blood cultures performed in BACTEC media and were assessed for four weeks in aerobic and anaerobic conditions. Identification of isolates and antibiotic susceptibility test were performed by standard methods. 24.6% of blood cultures were positive. The prevalence of polymicrobial bacteremia was 12%. Forty-three out of 65 isolated bacteria (66%) were gram positive and others (34%) were gram negative. Coagulase negative Staphylococci (21.5%), Propionibacterium spp (15.4%), Diphtheroid spp (12.3%), and Escherichia coli (12.2%) were the dominant isolated bacteria. All Staphylococci were methicillin resistant. The only isolated Pseudomonas putida and 37% of isolated Escherichia coli were multi-drug resistant. A number of Streptococci, Klebsiella, and Alcaligenes spp were also resistant in part to the antibiotics. Patients with cancer may be readily infected by many opportunistic pathogens including multi-drug resistant strains.

Leptospirosis is the most common zoonosis widespread in tropical and temperate countries with low social-economic status. We aimed to compare an ELISA kit with an in-house ELISA assay to test the serum samples of the patients who were suspicious of leptospirosis according to their clinical symptoms. A total of 282 serum samples of patients suspicious of leptospirosis admitted to hospitals in Rasht city (north of Iran) were examined for sero-diagnosis of leptospirosis. Blood samples were obtained with mean time of 6.36 days after the onset of the symptoms. Antibodies were detected using a commercial qualitative and by an in-house semi quantitative IgM and IgG ELISA and the results were compared with microscopic agglutination test (MAT) as the gold standard. All specimens with titers ≥320 against a pathogenic serovar in MAT were considered positive for leptospirosis. The results of MAT have demonstrated that 70 serum samples (24.8%) had a positive reaction with one of the leptospira serovar. The sensitivity, specificity, positive and negative predictive values were 87.1%, 91.0 %, 67.8%, and 95.5% for in-house ELISA assay, respectively, and 100%, 42.9%, 36.6%, and 100 % for commercial IgM ELISA assay, respectively. Our results showed that IgM ELISA assay is a reliable and sensitive method for the laboratory diagnosis of acute leptospirosis. In-house semi quantitative IgM ELISA was more specific and commercial IgM ELISA was more sensitive

Matricaria chamomilla (chamomile) is a herb used to treat various human illnesses. The present study was conducted to investigate the effects of chamomile extract on spermatozoon quality, serum levels of estradiol and testosterone, and sperm tail length in male adult rat. Male Sprague-Dawley rats received extract of chamomile (400 mg/kg once daily, orally) during an 8-week period, while the control animals received water. After this period, the animals were sacrificed and the blood samples were obtained. The serum levels of testosterone, estradiol, and the number, motility, and morphology of spermatozoon were assessed. The spermatozoon tail length was assessed by a rapid stereological method. The body weight, and weight, and volume of the testis in the control and experimental rats did not change significantly. Serum testosterone level was decreased (~76%, P<0.005) and the serum estradiol level was increased (~16%, P<0.04) in the experimental animals. The spermatozoon count and motility were decreased in the experimental group but spermatozoon morphology did not show significant changes. The mid-piece and total tail length were reduced in the experimental group (~22%, P<0.001). Matricaria chamomilla extract can decrease spermatozoa count and motility, spermatozoon tail length, serum testosterone level and increase serum estradiol level in male adult rat.

Adipose-derived stem cells (ADSCs) are a population of pluripotent cells used for tissue engineering purposes. The main purpose of the present study was to transdifferentiate the ADSCs to Schwann-like cells and to determine the intensity of apoptosis in ADSCs during the transdifferentiation process. ADSCs were isolated from the inguinal adipose tissue of adult rats and the identity of the undifferentiated ADSCs was confirmed by the detection of specific cells surface markers. The ADSCs were transdifferentiated by sequential administration of beta mercaptoethanol, all-trans retinoic acid and a mixture of forskolin, beta fibroblast growth factor, platelet derived growth factor and hergulin. The immunocytochemical properties of transdifferentiated Schwann-like cells were examined at specified time point. RT-PCR was used to investigate the gene expression of the undifferentiated and transdifferentiated ADSCs. Cell apoptosis was assessed with annexin/propidium iodide staining and 3-(4, 5-Dimethylthiazol- 2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Expression of Schwann cell marker S100 was determined by immunocytochemical staining. RT-PCR analyses revealed that the induced ADSCs exhibited Schwann cell-specific markers such as S-100, P75, and glial fibrillary acidic protein on the 14th day. MTT assay and flow cytometry studies showed that of the total ADSCs in the differentiation medium, 50% of the cells died by apoptosis, but the remaining cell population remained strongly attached to the substrate and continued to differentiate. ADSCs could differentiate to Schwann-like cells in terms of morphology and phenotype. An increased cell death rate was noted and the principle mode of cell death was apoptosis.

Phenylketonuria is a hereditary, autosomal recessive disorder caused by deficiency of phenylalanine hydroxylase or its cofactor tetrahydrobiopterin. The purpose of the present study was to evaluate the incidence of this disorder in southern Iran. All the neonates born between 22/Dec/2004 and 7/Sep/2007 were screened and their blood samples were tested by colorimetric and high performance liquid chromatography methods to obtain a diagnosis of phenylketonuria. Of the screened newborns (87091 females and 88143 males) 15 female and 13 male neonates were diagnosed definitely as having phenylketonuria. The incidence of phenylketonuria in girls and boys was 1.7 in 10000 and 1.5 in 10000, respectively (mean: 1.6 in 10000) in southern Iran (Fars province).

Insufficient sleep may lead to adverse cardio-metabolic effects by influencing body weight, blood pressure, and glucose tolerance. We aimed to assess the relation between sleep duration and indices of obesity including body mass index (BMI) and waist circumference in a sample population in central Iran. We selected a sub-sample of 1770 individuals from Isfahan Healthy Heart Program. The data regarding the sleep duration was collected by using a validated questionnaire. The relation of sleep duration with BMI and waist circumference was examined by using categorical logistic regression with adjustment for sex, BMI, and daily calorie intake. Sleep duration time less than 5 hours/day compared with 7-8 hours/day increased the odds ratio for abdominal obesity in people aged under 60 years [OR=2.49 (95%CI 1.40-4.43)]. In individuals aged under 60 years, this relation was significant for both men, [OR=2.64 (95%CI 1.16-6.02]) and women [OR=2.38 (95% CI 1.05-5.39)]. In addition, in women, sleep time > 9 hours was negatively related to waist circumference. Sleep duration time less than 5 hours per day increased odds ratio of overweight only in women [OR=1.75 (95% CI 1.07-2.85)]. Sleep duration time under 5 hours in people aged less than 60 years was positively associated with waist circumference. In women, sleep duration time over 9 hours was negatively associated with waist circumference. Only in women, sleep time under 5 hours /night increased BMI. Short sleep duration was associated with abdominal obesity and this was independent of its relation to BMI.

Thrombolysis for stroke is being used in some developing countries. This study was designed to evaluate the problems of thrombolysis therapy in Iran. During January-July 2008, all patients with ischemic stroke admitted to Ghaem Hospital, Mashhad, northeast Iran, were enrolled in a prospective observational study. Ghaem Hospital is a tertiary care hospital that includes infrastructure for thrombolysis with tissue plasminogen activator (tPA). The stroke onset to hospital entrance time, hospital entrance to completed investigation time, contraindications of thrombolysis, and the capability of the patients to afford the treatment costs by their own were recorded. Of the 625 patients with ischemic stroke, 50 (8%, 30 men, 20 women) arrived at hospital within a 3-hour time window. About 44% of these early arrived stroke patients remained within the 3-hour time window to complete computed tomography and laboratory tests. About 30% of these patients were capable to pay tPA cost by themselves. Contraindications of thrombolysis by tPA were found in 58% of these early arrived stroke patients. Seven patients (five men, two women) were eligible for intravenous thrombolysis. The major hurdles in implementing the treatment are the high cost of the drug and the lack of priority for triage and investigation of hyperacute stroke patients.

Swine flue is a highly contagious acute respiratory disease caused by a subtype of influenza A virus. Herein we present three patients with H1N1 infection complicated with pulmonary thromboembolism. The patients had chest pain and unexplained dyspnea. Imaging studies showed bilateral hilar predominance. Computed tomographic angiography confirmed bilateral thromboembolism (an unusual presentation of H1N1 infection). We did not find any predisposing factor including endothelial damage, stasis, or hypercoagulable state in these patients. They did not receive any medication. After anticoagulation and treatment with oseltamivir, all the patients were discharged in good condition. To the best of our knowledge bilateral pulmonary thromboembolism has not been reported in English language literature in patients with swine flu infection. Appropriate diagnosis and treatment will be life saving in this condition.

Basal encephalocele is a rare craniofacial anomaly. In the present paper we report a 10-year-old boy presented with cleft palate, congenital nystagmus, and hypertelorism. During preoperative evaluation for cleft palate repair, a pulsatile mass was detected in the pharynx. Magnetic resonance imaging showed sphenoethmoidal type of basal encephalocele and agenesis of corpus callosum. Neurosurgical consultation was performed for further evaluation and management.

Splenogonadal fusion is a rare congenital malformation whereby the splenic tissue is found attached or surrounded by the testis, and presents in both continuous and discontinuous forms. Splenogonadal fusion may be misinterpreted as a primary malignant testicular or an adenomatoid tumor. Knowledge about the existence of such an entity is essential in order to preserve the testis during surgical operation. We describe a case of splenogonadal fusion in a young man with bilateral normal oriented scrotal testis.