Presentation of Epicardial and Intrapericardial Hydatid Cysts: A Case Series

Hydatid cyst mainly involves the liver and lung; however, it can rarely involve cardiac tissue. This study describes the presence of hydatid cysts in the heart with considerable disease points in Tehran, Iran. Two cases aged between 25 to 50 years with cardiac hydatid cyst involvement were identified in 2021 in Tehran, Iran. Epicardial hydatid cyst between a left anterior descending coronary artery (LAD) and left obtuse marginal artery (OM) on the left ventricle, and in the second case, intrapericardial cyst attached to the pulmonary trunk with a thin base were identified. The cardial cysts were resected, and the patients recovered without any complications.  Cardiac hydatid cyst is a very rare disease. Rapid diagnosis and surgical and medical care are necessary for treatment

Identification of bacterial antigens and super antigens in synovial fluid of patients with arthritis: a cross sectional study

Abstract Background: An accurate and prompt diagnosis of bacterial arthritis is essential for earlier treatment and a good outcome. Superantigens produced by Staph. Aureus are among the most lethal toxins. The paper objective was Identification of common bacterial antigens and S.aureus superantigens in synovial fluid (SF) of children with negative culture and direct smear for other bacteria except for S.aureus. Methods: In this cross-sectional study a total of 62 patients with a mean age of 11 ± 3.8 years (range: 5 months- 16 years) with acute arthritis in pediatric and orthopedic wards of Rasoul hospital (2008-2010) were studied. Three common bacterial antigens (e.g. S.Pneumonia, H.influenza, N. meningitis) using LPA (latex particle antigen) and Staphylococcal superantigens (TSST1; Enterotoxin A; B; C) using ELISA method (ABcam; USA) were identified in 60 adequate SF samples with negative culture and negative direct smears (for other bacteria except for S.aureus. Staphylococcal superantigens were compared with S.aureus infection (positive culture or direct smear). Results: Positive bacterial antigens (LPA test) were found in 4 cases including two S. Pneumonia, one N.meningitis, and one H.influenza. S.aureus was diagnosed in 7 cases including 4 positive cultures and 3 positive smears. Staphylococcal superantigens (toxins) were found in 73% of SF samples. Some cases had 2 or 3 types of toxins. S.aureus toxins were reported in 47% of culture negative SF samples. Positive TSST1, Enterotoxin B, Enterotoxin A, and Enterotoxin C were found in 47% (n= 28), 18% (n= 10), 39% (n= 22), and 39% (n=21) of cases respectively. The most common type of superantigens was TSST1; and Enterotoxin A was the less common type. Except for Enterotoxin A, no relation between positive S.aureus culture and positive tests for superantigens in SF was found. Conclusion: S.aureus has a prominent role in septic arthritis. S.aureus toxins might have a prominent role in arthritis with negative SF culture. Rapid identification of bacterial antigens (LPA) or S.aureus superantigens (toxins) are valuable for diagnosis in cases with negative cultures. We recommend usage of complementary methods (e.g. antigen detection tests) in children. Those tests are cheaper and easier in comparison with PCR as a complex and time-taking method. Identification of S.aureus superantigens in SF of all cases

Serum Inflammatory Markers in the Elderly: Are They Useful in Differentiating Sepsis from SIRS?

Differentiating sepsis from other noninfectious causes of systemic inflammation is often difficult in the elderly. The aim of this study was to evaluate the ability of C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), procalcitonin (PCT), and Interleukin-6 (IL-6) to identify elderly patients with sepsis. In this single center prospective observational study, we included all consecutive elderly patients admitted with suspected sepsis and systemic inflammatory response syndrome (SIRS) in an emergency department. Blood samples for measuring CRP, PCT, IL-6, ESR and white blood cells (WBC) count were taken at first day of admission. Sensitivity, specificity, positive and negative predictive values were calculated for each inflammatory markers being studied. A total of 150 elderly patients aged 65 and older, 50 with sepsis and 50 with SIRS, and fifty individuals in a normal health status were included. CRP exhibited the greatest sensitivity (98%) and negative predictive value (98.6%) and performed best in differentiating patients with sepsis from those with SIRS. In a receiver operating characteristic curve analysis, IL-6 performed best in distinguishing between SIRS and the control group (AUC 0.75, 95% CI). On the other hand, both CRP and ESR appeared to be a more accurate diagnostic parameter for differentiating sepsis from SIRS among elderly patients

Serum Zinc Level in Children with Febrile Convulsion and its Comparison with that of Control Group

Objective: Febrile convulsion is the most common disorder in childhood with good prognosis. There are different hypotheses about neurotransmitters and trace element (such as zinc) changes in cerebrospinal fluid and serum, which can have a role in pathogenesis of febrile convulsion. The aim of the present prospective analytical case-control study was to determine whether there was any changes in serum zinc level in children with febrile convulsion during seizure. Methods: Ninety-two children aged 6 months to 5 years were divided into three groups: group A, 34 children with febrile convulsion, group B, 40 children having fever without convulsion, and group C, and 18 children with non-febrile convulsion. Serum zinc levels for the three groups were estimated by atomic absorption spectrophotometry (AAS). Data were analyzed to compare zinc level among the three groups using appropriate statistical tools employing SPSS 13. Findings: Serum zinc levels of groups A, B, and C had a mean value of 76.82±24.36mg/1, 90.12±14.63 mg/1 and 94.53±17.39 mg/l, respectively. Serum zinc level of group A was lower than those of the other two groups (P<0.006). It was also lower in group B than in group C (P<0.006). Conclusion: These findings revealed that serum zinc level decreases during infection; this decrease was more significant in patients with febrile convulsion

PCR-Based Assay for Rapid and precise Detection of Pseudomonas aeruginosa from Other Pseudomonas Species recovered from burned Patients

Abstract:Background: Pseudomonas aeruginosa is an important life threatening nosocomial pathogen which plays a prominent role in wound infections of burned patients. We designed this study to identify the isolates of P. aeruginosa recovered from burned patients at the genus and species level through primers targeting oprI and oprL genes; and analyzing their antimicrobial resistance pattern.Methods: during a 5 months period, wound samples were taken from burned patients and plated on MacConkey agar. All suspected colonies were primarily screened for P. aeruginosa by a combination of phenotypic tests. Molecular identifications of colonies were done using specific primers for oprI and oprL genes.Results: during a 5 months period bacterial isolates recovered from burn wound infections. Based on phonotypical identification tests, 171(34.8%) P. aeruginosa isolates, identified among burned patients; whereas by molecular techniques, just 133 p. aeruginosa yielded amplicon of oprL gene using species-specific primers, verifying the identity of P. aeruginosa; and the others yielded amplicon of oprI gene using genus-specific primers confirming the identity of fluorescent pseudomonads.Conclusion: This study indicates that molecular detection of P. aeruginosa in burn patients employing the OprL gene target is a useful technique in the early and precise detection of P. aeruginosa. It’s considerable that for the best aggressive antibiotic recommendation of P. aeruginosa strains at earlier stage, beside phenotypic tests, PCR detection should be done. It also has significant benefits on clinical outcomes

Comparing the performance of QuantiFERON-TB Gold and Mantoux test in detecting latent tuberculosis infection among Iranian health care workers

Objectives: The risk of transmission of Mycobacterium tuberculosis from patients with tuberculosis to health care workers (HCWs) has been well documented but little is known about the prevalence of latent tuberculosis infection (LTBI) in Iranian HCWs. The aim of this study was to determine the prevalence of LTBI among HCWs by using IFNgamma-release assay and compare the results with those of tuberculin skin test (TST). Methods: Two hundred HCWs were evaluated with both TST and QuantiFERON-TB Gold In Tube test (QFT-GIT). The obtained data were analyzed by SPSS v.16 Software. Results: The participants were 73 males and 127 females with the mean age of 34.36±8.26 years. TST was positive in 105 cases (52.5%) and the QFT results were positive in 17 cases (8.5%). There was poor agreement between the two tests (53%, к = 0.115). Induration diameter of TST ≥ 10 mm and working duration ≥ 10 years were independent predictors for positive QFT (p = 0.004). Conclusions: Due to the fact that BCG vaccination has been administered routinely to all HCWs in Iran, specifi c tests should be introduced for high risk groups. QFT thus seems to be more effective for LTBI diagnosis than TST among HCWs with BCG immunization history

Investigation of Class I, II and III Integrons among Acinetobacter Strains Isolated from Ventilator-Associated Pneumonia Patients in Intensive Care Unit of Rasoul Akram Hospital in Tehran, Iran

Background: Multi-drug resistant strains of Acinetobacter spp. have created therapeutic problems worldwide. The objective of this study was to detect integrons  in Acinetobacter  spp. isolates  from Ventilator-Associated  Pneu- monia patients using PCR method. Methods: A total 51 Bronchoalveolar lavage samples were obtained from patients in ICU and examined for Acinetobacter spp. infection by biochemical and PCR methods using blaOXA51-like primers. Antimicrobial susceptibility testing was performed using disk diffusion and MIC methods. Results: Among 51 patients with VAP (62.7% males, 35.2% females, mean age 53 year), 50 (98%) were positive, with a high prevalence of gram-nega- tive bacteria, mainly Acinetobacter spp. (70%), from which A. baumani was detected in 34 (68%) and A. lwoffii in 1 (2%) of isolates. More than 90% of isolates were resistant to imipenem,  piperacillin+tazobactam,  third genera- tion cephalosporins and gentamicin, while the most effective antibiotic was colistin (100%). The correlation coefficient between disk diffusion and MIC was 0.808 (p = 0.001). Three Acinetobacter isolates (8%) harbored integrase I gene but none of isolates contained Class II or III integrons. Conclusion: The results showed that colistin was an effective antibiotic and can be used for treatment  of patients in ICU. Due to the high number of MDR isolates lacking Integrons it can be concluded that although class I in- tegrons are important among clinical isolates of A. baumannii, they have no significant  role  in  dissemination  of  antibiotic  resistance  genes  in  Rasoul Akram  Hospital in Tehran, Iran. The presence of IntI in A. lwoffii may be related to transfer of integron to A. baumannii which can be considered as an important threat for hospitalized patients