Fascioliasis associated with chronic cholecystitis in a woman from Sistan and Baluchestan province, a non-endemic region in Southeastern Iran.

BACKGROUND: Fascioliasis, caused by Fasciola hepatica, is a neglected zoonotic food-borne trematodiasis. The Caspian littoral in northern Iran is endemic for the disease, and human fascioliasis is well-known in that region. In the present study, we report the diagnosis, identification, and clinical management of a human case of fascioliasis associated with common bile duct (CBD) obstruction from a non-endemic remote area in southeastern Iran. CASE PRESENTATION: A 42-year-old female was admitted to Afzalipour Medical Center hepatobiliary surgery ward in Kerman with abdominal pain for the past three months. Dilated biliary tract and an ill-defined mass in CBD were reported in abdominal ultrasonography and magnetic resonance cholangiopancreatography, respectively. During distal CBD operation, nine leaf-like motile flatworms were isolated. A morphological study confirmed all the isolates as Fasciola, and further molecular investigations, identified the flukes as F. hepatica using both pepck multiplex PCR and cox1 sequencing. CONCLUSION: Molecular and morphological findings of the study indicated the presence of human fascioliasis in the southeastern province of Sistan and Baluchestan in Iran. Fascioliasis is among the etiologies of chronic cholecystitis, and physicians should consider chronic cholecystitis associated with fascioliasis in the differential diagnosis. In the present report, endoscopic ultrasound was usefully applied for the accurate diagnosis of biliary fasciolosis.

Iranian Hydatid Disease Registry: Establishment and Implementation of a Neglected Tropical Disease Registry.

BACKGROUND: Cystic echinococcosis (CE) or hydatid disease is a global public health concern which imposes considerable economic costs on the communities in endemic regions. CE surveillance data are not adequately reliable. The present study reports the development and outcomes of a CE registry in Iran. METHODS: Hydatid Registry (HydatidReg) was initially established as a single-center registry in 2014 after the ethical approval of KMU. Following a call from MoHME to promote registry of different diseases and health outcomes, a call for participation was announced and all the Iranian Universities of Medical Sciences were requested to contribute to the registry. Subsequently, a nation-wide registry of hydatid disease was established in 2016. With a global perspective, HydatidReg joined the European Register of Cystic Echinococcosis (ERCE). A data collection form based on minimum dataset was designed and standard operating procedures (SOPs) were prepared to ensure standardized patient enrolment in the registry. A biobank system with two-dimensional barcoding was established along with HydatidReg for management and organization of biological specimens. RESULTS: As of March 2021, a total of 690 patients were enrolled in the registry. HydatidReg registered 362 (17.3%) out of the total 2097 patients enrolled in ERCE. Quality control (QC) of the data demonstrated 91.2% completeness and 80% timeliness. In the biobank, 322 biological specimens from 184 CE patients have been deposited including 70 blood, 96 sera and 156 parasite materials. CONCLUSION: High-quality data in the HydatidReg registry provided opportunities for health professionals to improve quality of care and organize meaningful research.

Genetic Profile of Hydatid Cysts in Patients with Multi-Organ Involvement: Mixed Infections by Different Strains.

Our knowledge on the susceptibility of humans to different genotypes of the zoonotic tapeworm Echinococcus granulosus and the genetic make-up of the cysts in multi-organ involvements is limited. This study aimed to identify the genotype profile of E. granulosus in patients undergoing hydatid surgery in an endemic area for cystic echinococcosis (CE) in southeastern Iran. Individuals who underwent hydatid cyst surgery were included in this study. Protoscoleces/germinal layers from each individual isolate were washed and kept in -20°C until use. Genotyping was carried out using PCR-sequencing of two mitochondrial CO1 and ND1 genes. Molecular phylogeny and haplotype network analysis of the human isolates were carried out using sequence data obtained from this study and National Center for Biotechnology Information (NCBI) databases. Forty-two patients (23 women and 19 men) participated in the study; the mean age was 43 years. Eighteen (42.9%) and 24 (57.1%) patients were infected by E. granulosus sensu stricto (G1-G3) and Echinococcus intermedius (G6 genotype), respectively. Molecular study showed mixed infection of G1 (in the liver and right lung) and G6 (in left lung) in a patient. The study showed a significantly high proportion of CE patients infected with the G6 genotype particularly in the southern parts of the province. In the present study a human CE patient infected by two species/genotypes of E. granulosus sensu lato is documented.

Preoperative Oral Pregabalin Reduces Acute Pain after Thoracotomy.

BACKGROUND: Nowadays pain control is one of the most important challenges for physicians, surgeons and anesthesiologists. New drugs and procedures to control pain have always been a major topic for researches. AIM: In this study, we evaluated the effects of preoperative pregabalin administration on relieving postoperative pain after thoracotomy surgery. MATERIALS AND METHODS: This study is a randomised, double-blind clinical trial, performed on 60 patients who underwent thoracotomy at Afzalipour hospital in Kerman, Iran. They were divided into case and control groups. Two hours before surgery an oral capsule of 300 mg pregabalin or placebo was given to patients. All patients similarly underwent general anaesthesia. Pain, nausea and vomiting were evaluated based on the visual analogue scale (VAS) and frequency. This study was verified and obtained the ethics committee code of K/92/489 from Kerman University of Medical Sciences. RESULTS: The average age of the pregabalin group was 39.7 ± 5.8 years and the control group 41.3 ± 6.1 years. The average pain score after regaining consciousness was 6.1 ± 0.2 in the case group and 7.9 ± 0.1 in the control group, and there was a significant difference between the 2 groups (p-value = 0.002). In the control group, 2 patients and the intervention group 3 patients, experienced nausea and vomiting. There was a significant difference between the overall average pethidine consumption and the average visual analogue scale in both groups. CONCLUSION: Pregabalin administration before thoracotomy is effective to reduce postoperative pain in patients. More research is needed to determine the optimal dose of pregabalin for preoperative administration.

Impact of Opium Addiction on Levels of Pro- and Anti-inflammatory Cytokines after Surgery.

BACKGROUND: Opium addiction alters immune responses to stresses such as an injury due to changing the secretion of cytokines. The present study assessed the effect of opium addiction on the cytokines [tumor necrosis factor α (TNFα), interferon-γ (IFN-γ), interleukin-4 (IL-4), and IL-10] before and after laparotomy. METHODS: Male rats were randomly divided into control and opium addicted (n = 20). Then, cytokines were measured before surgery, immediately after surgery (within 30-60 minutes) and 24 hours after surgery. FINDINGS: IFN-γ was raised in an addicted group in three phases of the study as compared to that of the control group. IL-4 in opium addicted group decreased in two phases after surgery compared to the control group. IL-4 was lower after surgery in comparison to before surgery in the opium addicted group. The difference in IL-10 and TNFα levels was not statistically significant in the all groups measured in three phases of the investigation. CONCLUSION: The results revealed that opium addiction can increase plasma level of IFN-γ in rats and decrease plasma level of IL-4 after surgical stress. It seems that opium addicted rats are a more susceptible to increased inflammation.

Comparison of Scolicidal Effects of Amphotricin B, Silver Nanoparticles,_and Foeniculum vulgare Mill on Hydatid Cysts Protoscoleces.

BACKGROUND: Surgery is the preferred treatment for hydatid cyst (cystic echinococcosis, CE). At present, various scolicidal agents have been used for inactivation of protoscoleces during surgery, but they are associated with adverse side effects. The aim of the present study was to evaluate the scolicidal effects of amphotricin B, Silver nano particles, Foeniculum vulgare Mill, essential oil and hypertonic saline against protoscoleces of hydatid cyst on an in vitro model. METHODS: Protoscoleces were aseptically aspirated from the naturally infected livers of sheep and goats. Various concentrations of AmB (2.5-20 mg/ml), Ag-NPs (0.5-4 mg/ml), F. vulgare essential oil (0.125-1 mg/ml) and hypertonic saline (10-20%) were used for 5-60 min. Eosin exclusion test was used to determine the viability of protoscoleces. RESULTS: Maximum protoscolicidal effect of AmB and Ag-NPs was found at concentrations of 20 and 4 mg/mL, resulting in only 82.3% and 71.6% of the protoscoleces after 60 min of incubation, respectively. In contrast, F. vulgare essential oil at concentration of 1 mg/ml and hypertonic saline 20% killed 100% protoscoleces after 5 and 10 min of exposure, respectively. CONCLUSION: The results indicated weak scolicidal activity of AmB and Ag-NPs; whereas F. vulgare essential oil had potent scolicidal activity against protoscoleces of hydatid cyst that revealed the potential of F. vulgare as a natural source for the production of new scolicidal agent for use in hydatid cyst surgery. However, further studies will be needed to confirm these results by checking the essential oil and its active component in the in vivo model.

Efficacy of Dressing with Absorbent Foam versus Dressing with Gauze in Prevention of Tracheostomy Site Infection.

BACKGROUND: Tracheostomy site infection can cause numerous problems. Absorbent foam dressing may be able to prevent proliferation of infectious microorganisms by absorbing the tracheostomy stoma exudate. This study aimed to compare the efficacy of absorbent foam with gauze dressing for prevention of tracheostomy site infection. MATERIALS AND METHODS: In this double-blind randomized clinical trial, 80 patients (18 to 60 years) hospitalized in the intensive care unit (ICU) due to severe head injury were randomly divided into two groups and early tracheostomy was done for them during the first 2 days. In the first group, gauze was used as tracheostomy site dressing, while in the second, absorbent foam, was placed. Tracheostomy site was checked daily for any sign of infection and samples were taken from the stoma for culture in case of presence of any sign of infection. RESULTS: Of a total of 80, 11 had tracheostomy site infection (13.75%), including 7 (17.5%) in the gauze group and 4 (10%) in the foam group. The difference in this regard between the two groups was not significant (P=0.051). Also, the dominant strains in the culture of gauze group were hospital-acquired Gram-negative bacteria (particularly Acinetobacter), while in the foam group, Gram-positives and more commonly Staphylococcus epidermidis were found. CONCLUSION: Absorbent foam dressing is not superior to gauze dressings for prevention of tracheostomy site infection.

Pulmonary complications of gastric fluid and bile salts aspiration, an experimental study in rat.

OBJECTIVE(S): Gastroesophageal Reflux Disease (GERD) is one of the most common digestive disorders that frequently lead to pulmonary complications due to gastric fluid aspiration. In the present experimental study, chronic aspiration of gastric fluid, its components and bile salts in rat lung was performed to find out the main factor(s) causing pulmonary complications of gastric fluid aspiration. MATERIALS AND METHODS: Forty eight male rats weighted 250-300 g were selected in six groups. After anesthesia and tracheal cannulation, the animals received 0.5 ml/kg normal saline, 0.5 ml/kg of whole gastric fluid, 0.5 ml/kg pepsin (2.5 µg/ml), 0.5 ml/kg hydrochloric acid (pH=1.5) or 0.5 ml/kg bile salts (2.5 µg/ml) by injection into their trachea and lungs. In sham group nothing was injected. RESULTS: Parenchymal and airways inflammation and fibrosis of bronchi, bronchioles and parenchyma were significantly more in the test groups compared to saline and sham groups (P<0.001); also inflammation in pepsin and bile salts groups (histopathology scores: 2.87±0.35 and 3.0±0.0 for bronchial, 2.87±0.35 and 2.87±0.35 for bronchioles, 2.87±0.35 and 2.87±0.35 for parenchymal inflammation) were more than hydrochloric acid and gastric fluid groups (1.75±0.46 and 2.5±0.53 for bronchial, 2.0±0.0 and 2.0±0.0 for bronchioles, 2.0±0.0 and 2.0±0.0 for parenchymal inflammation) (P<0.05). The same results were found for fibrosis, so that the fibrosis in pepsin and bile salts groups were more than hydrochloric acid and gastric fluid groups (P<0.05). Conclusion : The present results suggested that pulmonary complications causing from bile salts and pepsin might be more than gastric juice and hydrochloric acid.

Mucinous subtype of invasive ductal carcinoma arising within a fibroadenoma.

Fibroadenoma is a common benign tumor observed during the second and third decades of life. Malignancy transformation in the epithelial component of a fibroadenoma is rare and can occur 20 years after its diagnosis. Mammographic findings in this phenomenon include indistinct margins and microcalcifications. Here we present a 58-year-old woman with a mobile, lateral upper quadrant mass that was rather firm when palpated. The mammography showed a lobulated mass without calcification suggestive of a benign process, most probably fibroadenoma. However the excisional biopsy contained both an intracanalicular fibroadenoma and invasive ductal carcinoma with mucinous components.

Association between anti-thyroid peroxidase antibody and asthma in women.

About 8% of the general population suffers from autoimmune diseases, from which 78% are women. One of the most important causes of thyroid diseases is autoimmunity in origin, and it seems that people with thyroid diseases present more signs of asthma. This study was therefore designed to investigate the frequency of autoimmune thyroid diseases in women suffering from bronchial asthma.In a cross-sectional study, 100 women with asthma and 100 women as control group were tested for thyroid function and anti-thyroid peroxidase antibody (anti-TPO Ab) measurements. The asthmatic patients were selected based on having chronic cough, dyspnea, wheezing and clinical examination of the chest. The diagnosis was confirmed by pulmonary function tests. Blood tests were done by electrochemiluminescence immunoassay method.No hyperthyroid patient was found in either group. Serum TSH and Total T4 levels were not statistically different between the two groups, but serum anti-TPO Ab levels in women with asthma (74±13.6 IU/ml) was significantly higher than control group (45.24±10.56 IU/ml). After adjusting the effect of age and BMI, the relationship between asthma and anti-TPO Ab (>50 IU/ml) was statistically significant (OR=3.3, P<0.01). Positive anti-TPO Ab in asthmatic patients may show presence of a hidden autoimmune thyroiditis in these patients. We suggested checking asthmatic patients for thyroid diseases.

Askin's Tumor with Massive Hemoptysis.

Askin's tumor is a rare neoplasm of the chest wall with a dismal prognosis and is usually observed in young subjects. We describe a 15-year-old female with massive hemoptysis who had an extensive thoracopulmonary tumor on chest CT. She underwent bronchoscopy which showed the location of the tumor in the bronchus intermedius. The biopsy obtained from the tumor enabled a diagnosis of Askin's tumor to be made. After induction of chemotherapy, hemoptysis stopped and her constitutional symptoms improved. We focus on the clinical features, imaging, and histopathological characteristics of Askin's tumor.

Surgical management of femoral artery pseudoaneurysms secondary to drug abuse.

OBJECTIVE: To assess the outcome of surgical management of mycotic false aneurysms due to local injury after intravenous injection of drugs. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Surgery, Kerman Medical School of Sciences, Kerman, Iran, from July 2001 to June 2009. METHODOLOGY: Twenty one consecutive patients presenting with infected femoral artery pseudoaneurysms (IFAPs) secondary to parenteral drug abuse treated in our department were studied. Data analyzed included demographic characteristics, modes of presentation, side of involvement, management and outcome. RESULTS: All patients were male with mean age of 32.2 ± 5.2 years. All presented with pain and swelling in the groin. Five patients presented with significant hemorrhage. The locations were the left side in 9 cases and the right side in 12 cases. The injured artery was the common femoral artery and its bifurcation. In 14 patients (64%), ligation-excision was carried out. In 5 patients (26%), primary repair of the artery with over-sewing was done. In 2 patients (10%), revascularization with saphenous interposition was carried out. Below-knee amputation was necessary in 1 patient who underwent ligationexcision. One patient died due to severe septicemia. CONCLUSION: Ligation of IFAPs is an effective, safe and simple option. Primary repair with preservation of the native vessel is suggested if infection is limited.

Use of glasgow coma scale as an indicator for early tracheostomy in patients with severe head injury.

BACKGROUND: Early tracheostomy can reduce the time required for mechanical ventilation, the duration of ICU stay, and treatment expenses. Choosing the optimal time for tracheostomy in patients with severe head injury is therefore important. The purpose of this study was to find the optimal time for tracheostomy according to Glasgow Coma Scale (GCS). MATERIALS AND METHODS: In this prospective study, patients with severe head injury (GCS<8) admitted to the ICU of Kerman Shahid Bahonar Hospital were evaluated every day according to their GCS, and possible need for tracheostomy. RESULTS: Seventy-four patients were enrolled. The GCS of 49 patients on day 5 following ICU admission was <9. Forty-two patients (85.7%) eventually needed tracheostomy, and tracheostomy was not required in the remainder (14.3%). The prevalence of tracheostomy in patients with GCS >9 was 50%, and this difference was statistically significant. CONCLUSION: The present study showed that GCS of patients with severe head injury on day 5 following ICU admission may be used for decision-making regarding the time of tracheostomy. Tracheostomy should be carried out on day 5 following ICU admission if the GCS is ≤8, but it can be delayed if the GCS on the 5(th) day is >9.