Tehran University Medical Journal

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Background: Mycobacterium tuberculosis is a rare cause of mastoiditis, but diagnosis is often delayed, with potentially serious results.

Case: We report a case of tuberculous mastoiditis with unilateral hearing loss, facial paralysis, and cervical lymph adenopathy on presentation.                        

Conclusion: Tuberculous mastoiditis must be considered in all cases of chronic refractory mastoiditis especially in the presence of demonstrable complications such as facial paralysis, other cranial nerve palsies, and destruction of middle ear osscicles.

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Background: Prolonged endotracheal intubation is a growing method for supporting ventilation in patients who require intensive care. Despite considerable advancement in endotracheal intubation, this method still has some complications the most important is laryngo-tracheal injuries.                   

Methods: Over a 2-year period, this retrospective study was conducted on 57 patients with history of prolonged intubation who were referred to the ENT Department of Amir Alam Hospital. For each patient, a complete evaluation including history, physical examination, and direct laryngoscopy and bronchoscopy was done under general anesthesia.

Results: Fifty-seven patients (44 male mean age, 23.014.7 years) were studied. Mean intubation period was 15.88 days. The most common presenting symptom was dyspnea (62%). Head trauma was responsible for most cases of intubation (72.4%). The most common types of tracheal and laryngeal lesions were tracheal (56.9%) and subglottic (55.2%) stenosis, respectively. Mean length of tracheal stenosis was 0.810.83 cm. There was a statistically significant relationship between length of tracheal stenosis and intubation period (P=0.0001) but no relation was observed between tracheal stenosis and age, sex, and etiology of intubation (All P=NS). Among the glottic lesions, inter- arytenoids adhesion was the most common lesion (25.9%). No statistically significant relation was found between glottic and subglottic lesions and age, sex and intubation period (all P=NS). Length of stenosis and intubation period was significantly greater in tracheal/ subglottic lesions than those in glottic/ supraglottic lesions (all P=NS).

Conclusion: After prolonged endotracheal intubation, laryngo-tracheal lesions had no relation with patient’s age, sex, and cause of intubation.There was direct relation between length of tracheal stenosis and intubation period. Glottic lesions were more commonly observed in head trauma patients. Lesion length and intubation period were greater in tracheal and subglottic lesions.

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Background: Percutaneous Coronary Intervention (PCI) for bifurcated lesions is associated with a low rate of success and high rate of complications compared to such treatment of lesions of most other morphologies. Symptoms occurring at the time of procedure caused by PCI may require additional angiography with or without stenting through stent struts, which subsequently increases risks of restenosis and stent thrombosis. The purpose of this study was to evaluate the incidence of major side branch (>1mm) complications during PCI and their clinical, angiographic, and interventional predictors.
Methods: Of 104 consecutive patients, we evaluated 50 lesions with ostial stenosis (group 1) and 54 lesions without ostial stenosis (group 2) as a control group. Age, sex, major coronary artery disease risk factors, and left ventricular ejection fraction (LVEF), were compared between groups. Morphology, location, type of lesion, length of lesion, main and side branch diameters, interventional approach, and clinical and interventional outcomes were the main variables studied during this trial.
Results: Side Branch Compromise (SBC) occurred in 41 (39.4%) of the total number of cases: 52% in group 1 and 27.8% in group 2 (p=0.01). More than 80% of SBC occurred in main branches with stenosis (p=0.02). SBC did not correlate with clinical characteristics, bifurcation location, LVEF, or stent number. Chest pain was reported in 18% of the cases during or after PCI. Three non Q wave myocardial infarctions (MI) occurred after SBC, each with >2 mm branch diameters (p=0.02). SBC was not associated with adverse clinical outcomes.
Conclusion: The risk of MI after losing the side branch of a bifurcation lesion is not usually as high as it is after losing the main branch. Furthermore, it may not be a serious problem as one of the problems of the bifurcation lesion is the high rate of post procedural non Q wave MI associated with SBC. These findings demonstrate that side branch ostial stenosis >50%, and main branch stenosis >80% were important predictors of SBC. Protection of side branches >2mm is highly recommended during coronary intervention.

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Background: Platelet activation and aggregation plays an essential role in the for-mation of coronary artery thrombosis. Nowadays, the Clopidogrel is administered oral-ly as an inhibitor of platelet aggregation. Due to the high price of the original brand of Clopidogrel (Plavix), an Iranian brand of Clopidogrel (Osvix) has been produced. This study was conducted to evaluate the effectiveness, side effects and acceptability of lo-cally available brand of Osvix as anti platelet tablet in coronary artery bypass grafting patients in comparison to the original brand (Plavix) by means of platelet aggregation indexes. Methods: This clinical study, was conducted at Heart Center of Ekbatan university Hospital in Hamadan in October 2011 to May 2012. In this study 80 patients undergo-ing coronary artery bypass grafting (CABG) were participated in two independent treatment groups. One group used the Iranian brand of Osvix and other one used the original brand (Plavix) as an inhibitor of platelet aggregation. To evaluate the effective-ness of these two in-inhibiting platelets regimens, blood samples were taken from the patients and platelet aggregation test was performed using Helena Biosiences Europe, PACKS4 aggrigometry system (made in France). Results: Mean platelet-rich plasma amount for the Osvix and Plavix treatment group was 236.260 and 153.290 plt/µl respectively. Results showed a statistically significant difference in the rate of platelet-rich plasma by two above mentioned treatment groups. There was no observed statistical difference in side effects of two studied treatment groups. It must be noted that the effectiveness of Plavix tablet regimen as a platelet aggregation inhibitor in patients undergoing CABG was higher than the Osvix tablet treatment regimen. Conclusion: This study showed the Iranian brand of Clopidogrel (Osvix) is significantly different from the original brand (Plavix) in terms of performance factors in preventing platelet aggregation in patients undergoing coronary artery bypass grafting.

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Background: Staphylococcus aureus is the most important cause of nosocomial infections acquired in the community. Protein A is a major component of Staphylococcus aureus cell wall. In analysis of the nucleotide sequence Protein A encoding spa, locus x consists of 24 base pairs which repeat with high polymorphism. In this study, the spa gene of Staphylococcus aureus isolated from clinical specimens were obtained from patients admitted to the hospital and healthy carriers. Methods: In a cross-sectional study, a total of 200 samples were collected. One hundred fifty samples were obtained from hospitalized patients and 50 samples obtained from staff nasal swabs in Hamadan University Hospitals from October 2013 to August 2014. Disk diffusion antibiotic susceptibility tests performed. The antibiotics studied were Vancomycin (30 µg), Cefoxitin (15 µg) Gentamicin (10 µg), Tetracycline (30 µg), Trimethoprim/sulfamethoxazole (25 µg), Ciprofloxacin (5 µg), Erythromycin (15 µg), Clindamycin (2 µg), Rifampin (5 µg). The tests performed according to the guidelines of clinical and laboratory standards institute (CLSI). It also detect the mecA gene of Methicillin-resistant Staphylococcus aureus strains (MRSA) and genes spa which encodes the protein A by polymerase chain reaction (PCR). The PCR products using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method with enzyme Rsa I (Afa I) were prepared. Results: This methicillin-resistant Staphylococcus aureus strain (MRSA) had the highest sensitivity and resistance to ciprofloxacin and clindamycin. Totally, 8 amplicon with different sizes for the spa gene were identified. A total of 9 patterns polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) were found. Some of these patterns between Staphylococcus aureus isolated from clinical specimens and nasal carriers were common. Conclusion: There is a similar pattern of spa gene among patients admitted to the hospital and staff, according to our findings. Analysis of the patterns can reduced transmission of infection in both hospital staff and patients. Also it can help the physicians for correct management of infections.

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Background: Staphylococcus aureus is one the most common pathogens causing community-acquired infections and a major concern for public health, and the other hands antibiotic resistance is also of great concern for public health authorities also Staphylococcus aureus produce a lot of virulence factors such as variety of exoproteins included toxic shock syndrome and exfoliative toxin which causes colonization and different infections in their host. The aims of current study were to evaluate the prevalence of Toxic shock syndrome toxin 1 (TSST-1) and ETs genes in isolated S. aureus strains using polymerase chain reaction (PCR) assay. Methods: This cross-sectional study was performed on 100 methicillin-resistant staphylococcal aureus (MRSA) and 100 methicillin-sensitive staphylococcal aureus (MSSA) isolated from clinical specimens of inpatients, outpatients hospitals and nasal carriers in Hamadan University from October 2013 to August 2014. Identified species by biochemical methods were confirmed by the PCR method. Antibiotic resistance was performance by disk diffusion and the presence of TSST-1 and ETs genes was investigated using PCR. Results: Of the 100 isolates MRSA examined, the most frequent resistance was observed to ciprofloxacin (95%), followed by tetracycline (91%), erythromycin (92%), Gentamicin (90%), Rifampin (85%), trimethoprim-sulfamethoxazole (85%), clindamycin (80%) and cefoxitin (100%). Of the 100 isolates MSSA examined, the most frequent resistance was observed to erythromycin (68%), ciprofloxacin (66%), followed by tetracycline (52%), gentamicin (25%), clindamycin (46%), rifampin (45%), trimethoprim-sulfamethoxazole (66%) and cefoxitin (0%). Prevalence of TSST-1 and ETs genes were determined 13% (n=26) isolates, totally. Also the prevalence of TSST-1 was 11% (n=22) and ETs genes was 2% (n=4) isolates and none of the investigated isolates carried eta gene. Conclusion: The increasingly prevalence of MRSA and emerging its antibiotic resistance in clinical isolates can be considered a serious problem for public health. Detection of the high rate prevalence of TSST genes in current study is considered as a serious problem and existing and circle of these strains in according to colonization in community especially old people and immunocompromised patients is very serious.

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Background: Staphylococcus aureus is a gram positive coccus which is able to cause different kinds of infection in certain condition. The function of this bacteria is to provide the conditions for the invasion of it to the host with the secretion of different sorts of toxins such as Staphylococcus aureus enterotoxin, including important virulence factors that super antigens are all factors digestive inconvenience. Staphylococcus aureus enterotoxin-secreting toxins such conditions provides invasion of host genes. There are different types of SE, but type A enterotoxin (SEA) and type B enterotoxin (SEB) are the most important types. Therefore, in this study, the prevalence of Staphylococcus aureus toxin-producing enterotoxin genes (SEB, SEA) in clinical strains isolated from patients in teaching hospitals of Shahrekord city, Iran, were studied.

Methods: This cross-sectional and descriptive study, which was conducted from May 2014 to December 2014. A hundred and ten isolates of Staphylococcus aureus from patients collected over a period of 8 months and were first identified using standard biochemical methods and laboratory. Using standard methods and laboratory tests were identified and compared with the antibiotic oxacillin minimum inhibitory concentration were determined by broth micro dilution, and then they were assessed by polymerase chain reaction (PCR) technique.

Results: The results indicated that, 110 samples of dairy products infected by Staphylococcus aureus were detected. Two cases (1.8%) of these infected samples were carrying both enterotoxin A and enterotoxin B genes. The frequencies of enterotoxin A genes were twenty-six cases (23/6%) and The frequencies of enterotoxin B genes were two cases (1/8%), respectively.

Conclusion: The detection of enterotoxin A and enterotoxin B genes, shows the most important role they have in bringing about superinfection. The detection of enterotoxin A and B genes, shows the most important role they have in bringing about superinfection. Enterotoxins SEA and SEB are heat stable; therefore heating has no effect on dairy products contaminated by enterotoxins and gastritis may occur in a short period of time. As PCR is a rapid, sensitive, specific and inexpensive method, we suggest that it can be replaced to traditionally assays for detecting Staphylococcus aureus enterotoxin.

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Background: Self-immolation is a common method for suicide among women in developing countries. Culture is considered as an influential factor for attempting suicide by selfimmolation. Better understanding of the influence of culture will be useful to develop specific prevention strategies. Therefore, the study aimed to explore how the culture can influence on
attempting suicide by self-immolation among women.
Methods: The study was performed by a qualitative approach using directed content analysis in Imam Khomeini Hospital, Kermanshah, Iran, 2011- 2013. Our participants were selected purposefully among patients who attempted suicide by self-immolation (n= 9), their relatives (n= 6), and treatment staff (n= 6). We used semi-structure interview
for data gathering. The interviews were tape recorded and transcribed. Then, transcribed interview was analyzed by constant comparison.
Results: The main extracted theme was self-immolation sub-culture. Two main categories and 6 sub- categories were also emerged that explored the effect of culture on attempting suicide by self-immolation. The main categories were cultural restriction, and cultural acceptation. Marriage- divorced related traditions, living in extended family, and cultural
conversations and cultural meanings of self-immolation were among extracted subcategories. The category of cultural restriction described the role of culture in the occurrence of family conflicts as a predictor of attempting suicide by self-immolation, and cultural acceptation, the second category, explained how self-immolation is accepted as a
method of choice of suicide in the understudied culture.
Conclusion: Our finding showed that subculture of self-immolation provides influential conditions for attempting suicide by self-immolation. According to the findings, cultural restriction may facilitate conditions to occurrence of attempting self-immolation, and cultural acceptance provides conditions to perdurability of self-immolation as a method of
suicide. Considering these conditions is recommended in designing prevention programs.

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