Rapid screening of diabetic polyneuropathy : Selection of accurate symptoms and signs in an outpatient clinical setting

Authors would like to thank Ms. Ameneh Ebrahim Valojerdi for her great help in preparation of this manuscript.Peer reviewedPublisher PD

Correlation of dysoxia metabolism markers with trauma scoring systems in multiple trauma patients admitted to the emergency department: A cross-sectional observational study

Background: All the trauma scoring systems (TSSs) have some limitations, and none is useful for patient monitoring. Recently, investigators have tried to modify the TSSs to improve their use. Aims: This study was conducted to determine whether any correlation exists between dysoxia metabolism markers (DMMs), including venous base deficit (BD) and HCO3level with different TSSs. Materials and Methods: In this cross-sectional study, all multiple trauma patients admitted to the emergency department were eligible. Blood samples for venous blood gas analysis were taken at the onset of resuscitation process. TSSs, including trauma index (TI), abbreviated injury score (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma Score-ISS (TRISS), were calculated for the patients. Spearman's rank correlation coefficient test was applied to find the association between the independent variables. Results: A total of 285 patients with a mean age of 33.37 ± 15.29 fulfilled the inclusion criteria, of which, 211 cases (74.0) were male. Statistical analysis revealed that there was a correlation between TI and HCO3level (P = 0.0001, r = 0.37) and also TI and BD (P = 0.0001, r = 0.47). Furthermore, there was an indirect correlation between AIS and ISS with HCO3and BD levels and the direct correlation between RTS and TRISS with HCO3and BD levels. Conclusion: It is likely that there is a statistical correlation, although weak, between TSSs with DMMs, including HCO3and BD level

History of treated pulmonary tuberculosis will also be an underlying symptom of opportunistic aspergillosis by Aspergillus flavus: A case report

AbstractIntroductionAspergillus species as cosmopolitan fungi with remarkable virulence factors were found to be agents of pulmonary aspergillosis in patients with impaired immunity. The formed cavity of some previously treated lung diseases, such as tuberculosis, sarcoidosis and pneumoconiosis, is usually predisposed to the development of aspergillosis.Pulmonary aspergillosis (PA) is an uncommon disease which is characterized by hemoptysis, malaise, fever, cough, weight loss and nonspecific radiographic manifestations, including an oval or round mass with a radiolucent halo or crescent of air, a focal consolidation, and cavitary lesions.Case presentationThis study presents the case of a 54-year-old woman with dyspnea alongside a history of treated pulmonary tuberculosis (PTB) by ATT 2years ago. X-ray confirmed the presence of a rounded mass in a surrounding cavity in the lung. Tracheobronchial and chest CT images of the patient showed cavities with tuberculous nodules. Clinical symptoms of the patient were fever, malaise, anorexia, weight loss, chest pain, cough and dark mucus sputum. Aspergillus sp. was detected primarily as branching hyaline hyphae in direct examination of the sputum by calcofluor-white staining. The sample was positive with culture as well. Aspergillus flavus was identified in culture and confirmed by polymerase chain reaction (PCR) and sequencing of the ITS region of rDNA and β-tubulin of fungus. The patient signed an agreement for reporting her case as a medical document in journals or in conferences.ConclusionThe importance of tuberculosis (TB) in the development of aspergillosis, even after treatment, has been highlighted by multiple studies. Microbiological and molecular evaluation are needed to detect PA quickly and accurately. The WHO reported about 8.8million new cases of TB in 2010. Therefore, it is essential to focus more on monitoring of diagnosis and treatment of PA

First report of tinea corporis caused by Trichophyton quinckeanum in Iran and its antifungal susceptibility profile

Background and Purpose: Trichophyton quinckeanum, a known zoophilicdermatophyte responsible for favus form in rodents and camels, is occasionally reported to cause human infections.Case Report: This study aimed to report a case of tinea corporis caused by T. quinckeanum that experienced annular erythematous pruritic plaque with abundantpurulent secretions. In June 2021, a 15-year-old girl with an erythematous cup shape lesion on the right wrist bigger than 3 cm in diameter was examined for tinea corporis. Since March, 2016 her family has kept several camels at home. Direct examination of skin scraping and purulent exudates revealed branching septal hyaline hyphae and arthrospore. Morphological evaluation of the recovered isolate from the culture and sequencing of ITS1-5.8S rDNA-ITS2 region resulted in the identification of T. quinckeanum. Antifungal susceptibility testing showed that this isolate had low minimum inhibitory concentration (MIC) values for luliconazole,terbinafine, and tolnaftate, but high MICs to itraconazole, fluconazole, posaconazole, miconazole, isavuconazole, ketoconazole, clotrimazole, andgriseofulvin. However, the patient was successfully treated with oral terbinafine andtopical ketoconazole.Conclusion: It can be said that T. quinckeanum is often missed or misidentified due to its morphological similarity to T. mentagrophytes/T. interdigitale or other similar species. This dermatophyte species is first reported as the cause of tinea corporis in Iran. As expected, a few months after our study, T. quinckeanum was detected in other areas of Iran, in a few case

http://jhs.mazums.ac.ir IJHS 2013; 1(1):84 Investigation of Fungi in drinking water resources, as a source of contamination tap water in Sari, Iran

Abstract Background and purpose: One of the most prominent concerns for the water consumers is pathogenic microorganism contamination. Wells and underground water resources are the main resources of drinking water in Sari city, Iran. The main objectives of the research project were to explore the distribution and frequency of mycoflora in wells and underground water resources of the city and their contamination effects on humans. Materials and methods: Three reservoirs and 18 wells or underground water resources were analyzed. Water samples were then filtered and analyzed according to the World Health Organization guidelines. Each filter and 0.2 ml of suspension inoculated on SDA+CG media. For fungal growth, plates were incubated at 27'C for 7-10 days. The fungi were identified by standard mycological techniques. Results: Fungal colonies were isolated from all samples. From total of 160 fungal colonies isolated from wells water, 14 species of fungi were distinguished. Rhodotorula (54.4%), Monilinia (13.7%), Alternaria (6.9%) were the most commonly isolated. Drechslera, Rhizopus, and Exserohilum (0.6%) had the lowest frequency. There was no significant difference between fungal elements isolated from three major reservoirs (P>0.05). Conclusion: This study revealed that resources of drinking water from an area have to monitored and if its fungal CFU be greater than a certain value, medical and health preventive measures should be taken before the water is used by human. In this context, public and private awareness should also be provided through the media, broadcasting, teachers and scholars

Risk of Fungal Contamination of Ointments and Tablets after Opening of the Package for Use in Hospitals

Background and purpose: Tablets and ointments are used to prevent, treat, and diagnose diseases in hospitals. Although it seems that these medications are sterile in the path of the building and packaging, their mishandling or wrong application method can cause them to be contaminated. Hence, the preservation of pharmaceutical forms from contamination before and after opening the cover in hospitals is an essential measure to be taken in health care. The objective of the present study was to investigate the challenges in fungal contaminants detection and recovery in some pharmaceuticals that were high intake for patients.   Materials and methods:  This study was conducted in 4 teaching hospitals on 4 types of tablets and 3 types of ointments that were high intake for patients in hospitals before and after opening and usage in Sari, Iran. Fungi were identified by using standard mycology procedures. Results: The results showed that among the samples of tablets after opening the cover in the delivery room and carrying them in container by trolley, and the samples of ointments after opening and usage, the contamination rates were 70.3% and 94.4-100%, respectively. Aspergillus species such as A. flavus and A. fumigatus were the most mold species and Rhodotorula spp. was the most yeast species isolated. However, it was documented that 16.7% of some pharmaceuticals had fungal contamination ahead of opening. Conclusion: The results showed the contamination of ointments and tablets used in hospitals after opening the cover. Although the source of contamination was not investigated in the present study, the findings revealed that most of the contaminations could be due to the storage period and mishandling in pharmacies and wrong application methods after opening. Some isolated fungi can also be harmful to patients who have a weakened immune system

Coexistence of opportunistic mycosis and Mycobacterium tuberculosis in patients attending the Central Tuberculosis Reference Laboratory of Ghaemshahr city, Iran

Introduction: Opportunistic fungal organisms, such as Aspergillus and Candida species, tend to cause diseases in tuberculosis (TB) patients. Respiratory tract mycosis has clinical and radiological characteristics which are very similar to TB, thereby making the disease easily misdiagnosed. TB can be a predisposition to serious opportunistic fungal infections. Prolonged use of anti-TB drugs promotes the growth and reproduction of opportunistic fungi and, in turn, aggravates the course of the underlying process in the lung tissues. The study objective is to determine fungal coexistence with Mycobacterium tuberculosis (MTB) in patients attending the Central Tuberculosis Reference Laboratory of the Health Center in Ghaemshahr city, Iran. Material and Methods: Twenty-five participants were recruited into the study during two months. For each patient, three successive morning samples during one month were collected into sterile wide-neck universal sputum mugs. Specimen collection was taken for analysis at the Laboratory. None of the participants in this study had been placed on anti-fungal therapy. Sputa samples were studied for fungal elements and MTB. Direct microscopy by three stainings – KOH+Calcofluor white, Gomori-methenamine-silver and Giemsa – and fungal culture were done on Sabouraud Dextrose agar. Analysis for acid-fast bacilli (AFB) was done by the Ziehl–Neelsen technique. Results: A total of 75 fresh sputa samples were collected. Branching hyphae in 10 samples of 5 (20%) patients and pseudo-hyphae and blastoconidia in 12 samples of 5 (20%) patients were seen together with TB. Aspergillus flavus and Candida albicans were identified in the culture method and mycological exams. Discussion: Mycotic disease is an important coexistence in patients with TB. Although active mycosis may be an independent marker of advanced immunosuppression, it may also act as a co-factor in accelerating and amplifying the clinical course of TB disease. It is necessary in TB patients to increase the cure rate considering coexistencing opportunistic infections

The study of 101 cases of onychomycosis and associate factors in patients referred to Boali Sina Hospital and Toba dermatology outpatient clinics in Sari

(Received 20 May, 2009 ; Accepted 10 August, 2009)AbstractBackground and purpose: Onychomycosis is a nail fungal infection caused by various species of dermatophytes, yeasts and non-dermatophytic molds and represents about 30% of cutaneous mycotic infections. The goal of this study was to investigate the frequency of onychomycosis and its associated factors in patients referred to Boali Sina Hospital and Toba dermatology outpatient clinics, Sari.Materials and methods: In this cross-sectional study, nail specimens were collected from 101 patients suspected of onychomycosis during a 14 month period. Nail specimens were examined by direct microscopy, using potassium hydroxide (KOH) 20%, KOH + CFW, KONCPA (KOH treated nail clipping+PAS) and also culturing on sabouraud’s dextrose agar, containing chloramphenicol (SC), and sabouraud’s dextrose agar containing cyclohexamide and chloramphenicol (SCC) mediums.Results: In this study, 79 (78%) of patients were female and 22 (22%) were male. Yeasts were isolated in 30% cases of onychomycosis, mainly from fingernails. Candida albicans, and C.krusei was the most prevalent species. Non-dermatophytic filamentous fungi were yielded at 24%, especially from toenails, with Aspergillus terreus being the most prevalent species. Dermatophytes were found in 7% of the samples, especially from toenails. Trichophyton mentagrophytes was the predominant species. Unknown filamentous fungi were identified in 19% of samples, while mixed infections were identified in 20% of samples. The highest prevalence rate of onychomycosis was identified in the patients within the 30 to 49 years of age group. Distal and lateral subfungual onychomycosis (DLSO) was the most prevalent clinical types with (88%), followed by WSO (5%), PSO (5%), TDO (1%) and DLSO + PSO (1%).Conclusion: The results of our study showed that onychomycosis is one of the most prevalent infections in patients who are suffering from nail disorders. Yeast and yeast like organisms cause these infections more than other fungus in this region. Women are more infected, as they are in daily contact with detergents and moisturJ Mazand Univ Med Sci 2009; 19(71): 33-43 (Persian

Subcutaneous tramadol infiltration at the wound site versus intravenous administration after pyelolithotomy

BACKGROUND: Recently, the peripheral anesthetic effect of tramadol has been the theme of many studies. The postoperative analgesic effects of subcutaneous wound infiltration with tramadol have not been extensively studied and compared with those of intravenous administration. OBJECTIVE: To compare the therapeutic effects and complications of intravenous versus local wound infiltration of using tramadol following pyelolithotomy. METHODS: This double-blind study was carried out on 60 patients (age 18-60 y) of American Society of Anesthesiologists physical status I-II who were awaiting pyelolithotomy in Sina Hospital, Tehran, Iran, during 2006 and 2007. They were randomly assigned to receive intravenous or subcutaneous wound infiltration with tramadol. Vital signs, the intensity of pain (visual analog scale), and the level of consciousness (Ramsey Sedation Scale [RSS]), as well as the frequency of nausea and vomiting were recorded during 30 minutes to 1 hour after the patent entered the recovery room. Vital signs were also recorded every hour until 6 hours postoperatively and then on the day after the patient was transferred to the ward. RESULTS: The RSS was lower in patients who had received subcutaneous infiltration of tramadol (p < 0.001). A significant difference was noted in the severity of pain between the groups; it was higher in the group that received intravenous tramadol. The average time for the first meperidine requirement was 45.2 +/- 8.4 min (mean +/- SD) in the subcutaneous group and 21.6 +/- 12.4 min in the intravenous group. Total meperidine consumption was lower in patients who had received subcutaneous wound infiltration with tramadol compared with those who had received intravenous tramadol (p < 0.001). Nausea and vomiting were more frequent during the first hour of recovery; the complication, however, was less frequent in the subcutaneous group. CONCLUSIONS: Subcutaneous wound infiltration with tramadol reduces postoperative opioid consumption and produces less nausea and vomiting than does intravenous administration