فهرست مطالب

  • Volume:6 Issue:3, 2012
  • تاریخ انتشار: 1391/04/06
  • تعداد عناوین: 9
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  • Mohtaram Nasrollahi Page 104
    Introduction
    Mycobacterium tuberculosis complex (MTBC) are causative agents of human and animal tuberculosis.Differentiation of MTBC members is required for appropriate treatment of individual patients and for epidemiological purposes and reduction in drug resistances.
    Material and Methods
    1345 patients were collected with clinical suspicions of tuberculosis who referred to the Health Care Center of Mazandaran province from July 2010 to June 2011. The specimens were stained by the Ziehl-Neelsen staining technique and were cultured on Lowenstein-Jensen medium to detect the mycobacteria. For recognition of Mycobacterium tuberculosis complex MTUB-f and MTUB-r primer (gyrB-PCR1) were used. For differentiation of Mycobacterium tuberculosis complex members MTUB-756-Gf and MTUB- 1450Cr (gyrB-PCR2) and RFLP PCR using RsaI restriction enzymewere used.
    Results
    Of 1345 specimens, only 65(4.83%) isolates were positive culture of which59 (90.76%) were MTBC and 6 (9.24%) identified as Mycobacteria other than tuberculosis. All of 59 isolates were M. tuberculosis.
    Conclusion
    The gyrB-RFLP PCR and using the RsaI restriction enzyme is a rapid and easy technique to perform for differentiation of the member of M. tuberculosis complex.
    Keywords: gyrB, RFLP PCR, RsaI, Mycobacterium tuberculosis complex
  • Alireza Nateghian Page 108
    Background
    Visceral Leishmaniasis(VL) is a spreading potentially fatal zoonosis in Iran mimicking many other diseases in infancy which differs from VL in some other regions in terms of it’s clinical characteristics and response to therapy; earlier and better management is quite effective for life saving. Patients and
    Methods
    All cases with final diagnosis of VL,2months to 12 years who were discharged from Ali Asghar children hospital from 1976 to 2010 were enrolled in this descriptive-analytic retrospective study; demographic,clinical, paraclinical parameters as well data concerning initial response to treatment were gathered and analyzed by appropriate statistical methods by SPSS software.
    Results
    58 patients with final diagnosis of Kala azar were admitted in Ali asghar children hospital from 1976 to 2010.36 cases(62%) were male; mean age of patients was 30 months(SD=24.98); Most cases had been admitted in spring (21cases,36%) and winter(18cases,31%),43% were living in Tehran and around Tehran.Fever was the most common symptom and observed in 54 cases(93.1%)followed by splenomegaly,hepatomegaly,pallor and cough. There was a significant association between fever onset until admission and presence of splenomegaly(P value=0.015), weight loss(P vaue=0.025)and pallor(0.029).Most cases(93%) had been treated by Glucantime; mostly with doses less than 20 mg/kg/day and there was no significant difference regarding initial response(stopping fever) between those who got final dosages less than or equal to 20mg/kg/day and those who received higher doses.
    Conclusion
    Comparing to previous studies,there were some differences concerning presenting symptoms and signs on admission probably due to late diagnosis of VL in recently infected areas. Glucantime still has good effect for VL in Iran and it’s lower doses might also be effective for treatment although follow up studies are needed.
    Keywords: Kala azar, children, Iran, Leishmania infantum
  • Keyghobad Ghadiri Page 117
    Background
    Staphylococcus aureus (S.aureus) is an importantpathogen in human infections.Some strains of S. aureusare methicillin-resistant (MRSA) andcause hospital- and community-acquired infections in children. The aims of this study were to determine nasalcarriage rate of S. aureus and susceptibility pattern of this organism to some antibioticsamong children in Kermanshah province, Iran.
    Methods
    This was a cross-sectional study conducted in Kermanshah province, Iranfrom 2007 to 2008.Nasal swabs were obtained from 274 children who were hospitalized in our university hospital at the time of admission and 219 children upon dischargetime.If result of nasal culture was positive at admission time they considered community acquired and if result at admission time was negative but positive at discharge time they considered hospital acquired. Antibiotic susceptibility patterns of S.aureuswere done by disk diffusion method and results were compared between them.
    Results
    In 55 patients out of 274 cases (20.07%), S. aureus was demonstrated upon admission (community-acquired). In the remaining 219 cases, S. aureus was detected in 46 cases (21%) at discharge time (hospital-acquired). The rate of methicillin-resistant S. aureus (MRSA) in community- and hospital-acquired infections were 96.4% and 95.7%, respectively.We observed no statistical significance different in antibiotic resistance pattern between community acquired and hospital – acquired S.aureus except for co-triomoxcazol (P=0.034).
    Conclusion
    A high rate of MRSA in both community- and hospital-acquired infections were observed.
    Keywords: Methicillin, resistant S. aureus, Child, MRSA, Nasal carier
  • Esmaeil Mohammad Nejad Page 121
    Background
    HIV/AIDS is an infectious disease and the fourth cause of death in the world and.Iran and other Middle East countries are suffering from it.Medical staff, particularly nurses are at risk for bloodborne pathogens especially human immunodeficiency virus.We aimed to investigate educational needs of nurses about HIV/ AIDS.
    Methods
    In this cross-sectional study, 196 nurses of Imam Khomeini Clinical and Hospital Complexin Tehran were selected by simple random sampling method and completed self-administered two-part questionnaire, one dealing with demographic data and other inquiring knowledge and attitude of nurses about HIV/AIDS.The data was analyzed by SPSS version 16.
    Results
    Knowledge (66. 73%) and attitude (62.19%) of nurses regarding HIV/AIDS were good condition.There was no significant relationship between age, clinical experience and employment status with knowledge and attitude scores (p>0.05). There were significant relationship between history of nursing care of HIV patients and understanding ways of disease transmission (P=0.03).About knowledge acquisition methods 50.51% of subjects had gained through textbooks and retraining courses.87. 75% of nurses believed that HIV/AIDS patients should be supported, helped and treated.There was significant relationship between knowledge and attitude regarding HIV/AIDS (P=0.003).
    Conclusions
    continuing educational programs regarding AIDS for at risk groups such as nurses is recommended to maintain the ideal level of knowledge for increasing awareness.
    Keywords: HIV, AIDS, Knowledge, Attitude, Nurse
  • Vida Fallahian Page 124
    Introduction
    Rabies is a fatal disease and has a threatening risk for the public health.Immunosuppression is related to a wide variety of diseases. It is recommended that immunosuppressed patients receive the full post-exposure vaccination, concerning that the immune response may be inadequate. The aim of this study is to determine the level of rabies neutralizing antibody in immunosuppressed patients after receiving rabies post-exposure prophylaxis. Consequently we assess the efficiency of antibody level in immunosuppressed patients admitted at Pasteur Institute of Iran. Patients and
    Methods
    The study was performed at Pasteur Institute of Iran. Data related to immunosuppressed patients, doses of anti-rabies vaccine and serum, and level of rabies neutralizing antibody titer collected from the patients admitted to the Prevention and Treatment of Rabies Center, Department of Vaccination at Pasteur Institute of Iran, during 2008 to 2010. Subjects who received chemotherapy, immunosuppressive drugs, and chronic renal failure were included in this study.
    Results
    Twenty two cases were evaluated. The Immunosuppressed state was related to cancer (in 8 cases), 4 cases of hematologic disorders, 6 cases of autoimmune disease, and 4 cases of chronic renal failure or kidney transplant. Mean age of 46.45± 21.5 year. All cases received HRIG serum (human rabies immunoglobulin) plus PVRV (Purified Vero cell rabies vaccine). The level of rabies neutralizing antibody was checked two weeks after the last dose of vaccine. Mean level of rabies neutralizing antibody was 12.07± 6.72 IU/ml. All cases achieved minimum protective level of antibody which is ≥ 0.5 IU/ml. The amount of the antibody level had no relation to age or kind of immunosuppressive disease of patients.
    Conclusion
    It is recommended that Rabies-exposed immunosuppressed patients receive rabies post exposure prophylaxes. We have to be cautious about the cases who have not achieved the appropriate level of rabies antibody
    Keywords: Post, exposure rabies prophylaxis, Immunosuppressed patients, Rabies neutralizing antibody
  • Maliheh Metanat Page 128
    We have described four patients with Crimean- Congo hemorrhagic fever which acquired the illness following consumption of uncooked sheep liver. Three patients admitted to hospital nearly 36 hours after eating the liver with acute fever and with quick treatment they respond to therapy. Unfortunately, one patient who was referred late to hospital and treatment was after 5 days of the beginning of the first sign, died. Here in, we described four patients who consumed uncooked liver together in a party and apparently there were no other routes for transmission. Three of them were members of a family (one sister and two brothers) and the fourth was their friend who invited to their party
  • Parisa Azimi Page 131
    Background
    Brain abscess is an infrequent complication of meningitis, including cases caused by Gram-negative enteric bacteria and Klebsiella in neonates. Brain abscess in neonates associated with high morbidity and mortality. Recently, incidence of the disease is increasing because of increased predisposing factors.Patients: Three cases of brain abscess in neonates are reported, 2 of them were caused by Citrobacter meningitis while another case was caused by Klebsiella abscess following meningitis. All of the abscesses were enormous, and multiple abscesses were observed in 1 case. The abscesses were treated by aspiration and antibiotics. Shunt for hydrocephalus was necessary in all patients. No sources of infection were identified in three cases. The onset of infection was not clear in our cases. Finally, 1 patient could improvement while the other two patients were died. One extremely rare case of Klebsiella brain abscesses was reported.
    Conclusion
    All neonates with Citrobacter and Klebsiella meningitis should have neuroimaging studies performed due to the substantial risk of associated brain abscesses, even when suspicious signs are absent. Prompt diagnosis and treatment are essential to reduce the neurological morbidity and the risk of death.
    Keywords: Brain abscess, Klebsiella, Citrobacter, Neonate, Pediatric neurosurgery
  • Nariman Shahhosseini Page 136
    The opportunistic mould Aspergillus is a ubiquitous fungus. Diseases caused by Aspergillus species are most commonly caused by Aspergillus fumigatus. The spectrum of disease caused by Aspergillus is dependent on the health of the immune system. The ranges of illnesses individuals acquire are aspergilloma, allergic bronchopulmonary aspergillosis, invasive aspergillosis, sinusitis, otomycosis, ocular infections, CNS infection, osteomyelitis, cutaneous aspergillosis, endocarditis, urinary tract infection.Aspergilloma is the most common clinical presentations of lung infections due to Aspergillus species. Allergic Bronchopulmonary Aspergillosis is a result of an immune reaction to colonization of Aspergillus fumigatus within the airways of patients. Invasive aspergillosis is generally seen in severely immunocompromised individuals. Aspergillus sinonasal infections may or may not be invasive and can follow a fulminant or an indolent course. Otomycosis has typically been described as fungal infection of the external auditory canal. Aspergillus endophthalmitis may occur by several mechanisms, including direct inoculation by trauma after surgical procedures or by hematogenous spread. Central nervous system (CNS) aspergillosis is a rare and uniformly fatal complication of disseminated disease, involving the cerebral hemispheres and cerebellum. The mechanism for Aspergillus bone infections is by direct extension, traumatic injury, inoculation by a surgical intervention, hematogenous spread and injection drug abusers. Primary cutaneous disease is a rare disease caused by Aspergillus fumigatus. Aspergillus species have been reported as a cause of both native and prosthetic valve endocarditis. Aspergillosis of urinary tract may occur by three ways namely, by ascending infection from the lower tract, from haematogenous dissemination or due to Aspergillus cast in renal pelvis.
    Keywords: Aspergillus fumigatus, disease, aspergilloma, invasive aspergillosis