Seyed Mohammadreza Hashemian; Amir Vahedian Azimi; Mohamad Amin Pourhoseingholi
Edgar Vargas Flores; Claudia Leticia Avitia Raygoza; Daniel Hernández Castañeda; Jorge Arturo Sánchez Garza; Juan Carlos Quintana Cortéz
Abstract
Introduction: Burkitt lymphoma is an aggressive subtype of Hodgkin lymphoma with a doubling time of 25 hours. It is characterized by a MYC gene coding alteration which results from a translocation of chromosome 8 on the MYC gene locus and immunoglobulin heavy-chain locus (IGH) on chromosome 14. Even ...
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Introduction: Burkitt lymphoma is an aggressive subtype of Hodgkin lymphoma with a doubling time of 25 hours. It is characterized by a MYC gene coding alteration which results from a translocation of chromosome 8 on the MYC gene locus and immunoglobulin heavy-chain locus (IGH) on chromosome 14. Even though HIV infection is associated to an increased risk of Burkitt lymphoma, these type of malignancies are EBV-negative cases. Sporadic type Burkitt lymphoma is a rare clinical entity. Case Presentation: A 48-year-old female without any past medical history presented with a chief complaint of mild abdominal pain of 6 months duration located at the epigastrium which was not related to food ingestion. Nausea or vomiting were neither reported. She noted an acute increased abdominal pain over the last 4 hours before presentation, with irradiation to the right lower quadrant. She denied any Fever, night sweats and weight loss. She also reported hypermenorrhea in the last 6 months. During the physical examination, a palpable mass with 10 cm in diameter was found on right lower quadrant. Conclusion: Sporadic Burkitt lymphoma is one of the rarest hematologic malignancies. The increased tumor size may be more than enough to show clinical or biochemical abnormalities such as serum lactate dehydrogenase (LDH) increased and tumor lysis.
Shahram Manoochehry; Hamid Reza Rasouli
Maryam Yaghoubi; Marzieh Javadi; Saied Karimi; Elham Ehsani
Abstract
Background: Patient safety is a serious global public health issue. Estimates show that every day many patients are harmed while receiving hospital care. Health care staff plays a key role in providing quality and safe patient care, especially physicians who are main members of the medical team and a ...
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Background: Patient safety is a serious global public health issue. Estimates show that every day many patients are harmed while receiving hospital care. Health care staff plays a key role in providing quality and safe patient care, especially physicians who are main members of the medical team and a critical element in patient safety efforts. Objective: The current study used a Theory of Planned Behavior (TPB) framework to investigate predictors of patient safety intentions and behavior of physicians. Methods: This descriptive analytical study was conducted in 8 hospitals with 52 physicians participating. A researcher-designed questionnaire was prepared to investigate patient safety behaviors and behavior constructs of physicians based on the guidelines of constructing a TPB Questionnaire: Conceptual and Methodological Considerations. The content validity and reliability of the questionnaire were confirmed. Binary logistic regression analysis was performed using SPSS18. Results: The total mean score of physician safety behavior indicated that 3.8±0.92. 42% of physicians reported their safety behavior at a good level. There was no significant difference between the patient safety function of physicians in public and private hospitals (P=0.8) and working in medical or surgical wards (P=0.4). Among TPB constructs, “normative beliefs” had the greatest influence on physician intention for safety behaviors (wald=3.828, P=0.05). Conclusion: The results showed that “normative beliefs” had the greatest influence on physician intention for safety behaviors; therefore, it seems that patient safety must be the most important concern of all health care staff, specifically managers and executives throughout health care centers.
Mohammad Javad Behzadnia
Gholam Hossein Alishiri; Ehsan Rahmanian; Mahsa Ramezanpour
Abstract
Introduction: A case of pulmonary sarcoidosis is reported because of difficulties in diagnosis and treatment, including the co-existence of ankylosing spondylitis (AS) and severe corticosteroid dependence. Case Presentation: A 48-year-old nonsmoking woman referred to the hospital because of chronic nonproductive ...
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Introduction: A case of pulmonary sarcoidosis is reported because of difficulties in diagnosis and treatment, including the co-existence of ankylosing spondylitis (AS) and severe corticosteroid dependence. Case Presentation: A 48-year-old nonsmoking woman referred to the hospital because of chronic nonproductive cough and dyspnea with a 10-year history of AS. Bilateral rhonchi was detected in lung auscultation. There was a significant limitation in lumbar activity and range of motion in flexion (positive Schober’s test), extension, and lateral bending. In lumbosacral magnetic resonance imaging (MRI), irregularities in the sacroiliac joint and bilateral sacroiliitis were evident. The angiotensin-converting enzyme level was elevated. Biopsy in hilar lymphadenopathy by transbronchial lung biopsy was done, and the histopathological findings showed chronic non-necrotizing granulomatosis inflammation compatible with sarcoidosis. Anti-tumor necrosis factor drugs was effective on steroid-dependent coexisting of sarcoidosis and AS. The symptoms were absent in regular follow up. Conclusion: Pulmonary fibrosis due to sarcoidosis can be prevented by suitable treatment. Clinical trials are needed to confirm the impact of treatments with monoclonal antibodies against tumor necrosis factor (TNF), for curing sarcoidosis.
Reyhaneh Abolghasemi; Masoumeh Saeedi
Abstract
Introduction: The main symptoms of new coronavirus in patients are fever or chills, tiredness, and dry cough. In this case, we reported a woman who got involved in COVID-19 pneumonia with gastrointestinal instead of lower respiratory symptoms.Case Presentation: A 67 years old woman was referred to an ...
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Introduction: The main symptoms of new coronavirus in patients are fever or chills, tiredness, and dry cough. In this case, we reported a woman who got involved in COVID-19 pneumonia with gastrointestinal instead of lower respiratory symptoms.Case Presentation: A 67 years old woman was referred to an outpatient clinic in Tehran with fever, chills, sneezing, tiredness, severe nausea, anorexia, and diarrhea. She did not have a cough, dyspnea, or chest pain and her lung sound was normal. According to the blood O2 saturation decreasing, C-reactive protein increasing, and the lung imaging findings, she was admitted with COVID-19 pneumonia diagnosis in the infectious care department of a hospital. The 2019-nCoV real-time polymerase chain reaction (PCR) intranasal assay was negative. She was treated with intranasal oxygen therapy, anti-inflammatory drugs, and prednisone. After one week she was discharged in generally good condition and quarantined for two weeks later. After 25 days the COVID-19 IgM and IgG antibodies were in positive ranges.Conclusion: Severe fatigue, mainly in elders caused the inability to cough, and light inspiration force especially in the lower lung lobes could explain the normal lung sounds in the physical examination. Also, we hypothesized that reverse circulation of the virus may occur from the gastro intestine to the respiratory system. The gut-lung microbial imbalance may affect the severity in patients with extrapulmonary symptoms, especially in old ages. Furthermore, damage to the vagus nerve along the path in the proximity to lungs infected with COVID-19 can cause nausea without gastrointestinal involvement.
Hamidreza Torabi; Mohammad Riazi Esfahani; Seyed-Ali Tabatabai
Abstract
Background: Endophthalmitis is a severe and sight-threatening complication of ocular surgery or ocular trauma. The identification of common types and causative organisms is essential for prevention and management. Objective: The current study describes the prevalence of various types of endophthalmitis ...
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Background: Endophthalmitis is a severe and sight-threatening complication of ocular surgery or ocular trauma. The identification of common types and causative organisms is essential for prevention and management. Objective: The current study describes the prevalence of various types of endophthalmitis and the causative microbiological spectrum of each type treated in the Tertiary Referral Center in Iran. Methods: All cases of endophthalmitis admitted to the Emergency Department of Farabi Eye hospital (Tehran, Iran) between July 2013 and December 2014 were included in this study. The patients’ demographic data, type of endophthalmitis, aqueous or vitreous culture results, and treatment methods were recorded. Results: From 108 presumed endophthalmitis cases, post-operative endophthalmitis (68.5%) was the most frequent type followed by post-traumatic (25%), bleb-associated (4.6%), and endogenous (1.9%) types. Streptococcus viridians (37.5%) was the most common isolated organism in post-operative cases. In post-traumatic endophthalmitis patients, the most frequent causative organism was Staphylococcus epidermidis (70%). Conclusion: Many studies from other countries have reported that S. epidermidis is the leading cause of endophthalmitis after either intraocular surgeries or open-globe injuries, but the current study has shown that S. viridians is the most common isolated organism in post-operative endophthalmitis.
Gholam Hossein Alishiri; Ehsan Rahmanian; Mahsa Ramezanpour
Abstract
Inrtoduction: Granulomatosis with polyangiitis (GPA) is a systematic and necrotizing vasculitis with positive autoimmune antibodies. Some studies have reported the prevalence of eye involvement between 40%-50% of cases. Retro orbital granuloma is a rare complication of GPA which should be treated by ...
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Inrtoduction: Granulomatosis with polyangiitis (GPA) is a systematic and necrotizing vasculitis with positive autoimmune antibodies. Some studies have reported the prevalence of eye involvement between 40%-50% of cases. Retro orbital granuloma is a rare complication of GPA which should be treated by surgical involvements, while pachymeningitis can be diagnosed by MRI and treated by medical management. In this study, we tried to present a case of GPA with optic neuritis and typical central nervous system (CNS) involvement, while there were no definite features of sinusitis or kidney injuries. Case Presentation: A 15-year-old girl was admitted because of blurred vision in her left eye. She was a known case of GPA three years ago with initial features, including left facial nerve paresis due to pan-sinusitis and pulmonary cavity. Neurologic evaluations, including sensory and motor features, were normal, too. Ophthalmologic examinations showed that visual acuity of the right eye was good, while the visual acuity in the left eye decreased to the point of finger counting at a distance of 20 cm. The left eye Marcus gunn test was positive (3+); anterior and posterior eye segments were normal. The patient was evaluated by brain MRI with gadolinium and a pathologic enhancement in the left cavernous was seen which had a pressure effect on the optic nerve. She was treated by intravenous methylprednisolone followed by rituximab. Conclusion: Reporting orbital mass in a patient who had GPA can be supposed as granuloma which needs a biopsy to confirm a diagnosis. In our case, the imaging manifestation was heterodox for granuloma, while neurosurgical consultation recommended drug treatment for pachymeningitis.
Samaneh Shirazi; Jalil Rashedi; Behroz Mahdavi Poor; Mohammad Asgharzadeh; Seyyed Reza Moaddab
Tanvi Khetan; Abdulzahra Hussain; Ihsan Al-Shoek; Shamsi EL-Hasani
Abstract
Introduction: Broad ligament hernia was first reported post-autopsy by Quain in 1861. In a 1995 review article, only 61 cases had ever been reported. This paper presents a case report of broad ligament hernia and explores the literature surrounding this topic. Case Presentation: The patient presented ...
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Introduction: Broad ligament hernia was first reported post-autopsy by Quain in 1861. In a 1995 review article, only 61 cases had ever been reported. This paper presents a case report of broad ligament hernia and explores the literature surrounding this topic. Case Presentation: The patient presented with no significant past medical history, acute lower abdominal pain (several hours), nausea, and vomiting. Clinical examination showed a heart rate of 85 beats per minute; normal temperature, blood pressure, and respiratory rate; and a mildly distended abdomen with tenderness across the right lower quadrant. A plain abdominal X-ray showed dilated small bowel loops, and a blood test showed leukocytosis. Urgent diagnostic laparoscopy showed a broad ligament strangulated hernia with small bowel infarction. Reduction of the small bowel, resection, and side-side anastomosis were performed. The patient had an uneventful recovery, and follow up reported no postoperative complications. Conclusion: Laparoscopic management of small bowel obstruction due to broad ligament internal hernia is a safe and effective option.
Francesco Castagnini; Giovanni Bracci; Enrico Tassinari; Federico Biondi
Abstract
Introduction: Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure due to possible hardware-related complications. Case presentation: A 78-year-old female with hip osteoarthritis had a proximal femoral osteotomy fixed using a blade plate in the same femur 41 years ...
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Introduction: Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure due to possible hardware-related complications. Case presentation: A 78-year-old female with hip osteoarthritis had a proximal femoral osteotomy fixed using a blade plate in the same femur 41 years ago. A two-step approach was planned. After a challenging hardware removal, an iatrogenic subtrochanteric fracture below the degenerated hip occurred after three months. THA with a tapered long stem was successfully performed with no need for additional osteosynthesis, and good results were seen two years later. Discussion: THAs in subtrochanteric fractures are technically demanding but feasible in selected cases. Hardware removal before THA implantation may carry important risks, and the surgical team should be prepared to perform arthroplasty in case of complications. Conclusion: THA in a subtrochanteric fracture below hip osteoarthritis is a feasible option in selected cases.
Reza Bidaki; Seyed Nader Mostafavi; Sogol Al-Saeed; Motahhareh Karimoddini; Farzaneh Dehghani
Abstract
Introduction: Parquet poisoning has been elaborated to be very common among developing countries, particularly in regions with agriculture economy. One of the most common presentations of paraquat poisoning is oropharyngeal burns. Herein, we report a patient from a dry and warm district in the geographic ...
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Introduction: Parquet poisoning has been elaborated to be very common among developing countries, particularly in regions with agriculture economy. One of the most common presentations of paraquat poisoning is oropharyngeal burns. Herein, we report a patient from a dry and warm district in the geographic center of Iran where agriculture and, as a result, paraquat poisoning are not commonly reported. Case Presentation: A 25-year-old man presented to hospital subsequent to a suicide attempt by ingesting oral paraquat poison. He gradually developed odynophagia and trismus-like appearance that, after a psychiatric consultation, was misdiagnosed as a drug side effect in the form of dystonia. Upon further physical examination, oral ulcers on his tongue were revealed to be responsible for the symptom. Conclusion: Paraquat poisoning is very rare in regions with lower rates of agriculture activities. In any patient with poisoning, however, it is necessary to consider intraoral examination to rule out any other suspected diagnosis.
Mehdi Torabi; Fahimeh Shojaee; Moghaddameh Mirzaee
Abstract
Background: Kidney calculi are the most common cause of kidney failure.Objectives: This study aimed to investigate the prevalence of renal colic and its risk factors in the patients referred to two emergency departments during a year.Methods: This was a descriptive cross-sectional study conducted in ...
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Background: Kidney calculi are the most common cause of kidney failure.Objectives: This study aimed to investigate the prevalence of renal colic and its risk factors in the patients referred to two emergency departments during a year.Methods: This was a descriptive cross-sectional study conducted in two hospitals in Kerman city, south-east of Iran, for one year from March 2019 to March 2020. All the archives of the two emergency departments were reviewed, and the required information was recorded in a checklist. The data was analyzed in SPSS 20 software.Results: A total of 504 patients were included in the study. The prevalence of renal colic was 0.5%. Most of the patients (58.5%) had an age between 19 and 39 years, and the majority (60.1%) were males and had a body mass index (BMI) above 25. A family history of renal colic was reported in 68.7% of the patients, and 63.9% had either hypertension or diabetes. Most of the patients consumed less than 3 liters of water per day. The highest referrals were seen in autumn (31.5%) and summer (27.4%).Conclusion: Considering the relationship between renal colic and age, sex, BMI, occupation, a family history of the disease, the presence of underlying diseases, the amount and type of drinking water, and the season of referral, it is recommended to control these risk factors to reduce the incidence of the disease.
Seyed Mohammad Javad Hosseini; Jaleh Yousefi; Habib Yaribeygi; Gholam Hossein Alishiri
Abstract
Introduction: Cranial nerve palsy in Wegener’s granulomatosis is a curious incident, particularly if it occurs without kidney or lung involvement. In a review of medical articles, only 1 case of Wegener’s granulomatosis with bilateral facial nerve palsy was found. Case Presentation: The patient ...
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Introduction: Cranial nerve palsy in Wegener’s granulomatosis is a curious incident, particularly if it occurs without kidney or lung involvement. In a review of medical articles, only 1 case of Wegener’s granulomatosis with bilateral facial nerve palsy was found. Case Presentation: The patient was a 16-year-old female who presented with pain and hearing loss in both ears and reduced muscle tone in the right side of her face. After myringotomy and ventilation tube embedding in both ears, she gradually developed infectious otorrhea in both ears. Despite antibiotic and antifungal therapy for 2 weeks after surgery, the patient developed paresis in the left facial nerve and gag reflex disorder. Both magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) tests were normal, but the C-anti-neutrophil cytoplasmic antibody (CANCA) test result was about forty times higher than normal, and a sinus biopsy also verified Wegener’s granulomatosis. The patient was then treated with pulse corticosteroid and cyclophosphamide therapy. Her gag reflex healed and the ear secretions stopped, but the facial nerve palsy continued. Conclusion: Although cranial nerve involvement in Wegener’s granulomatosis is an unusual incidence, it may occur in some cases. In the current case, otitis media and cranial nerve paresis without kidney or lung disorders were the only signs of disease onset; of course, computerized tomography (CT) scan revealed a right mandibular sinus disorder without any clinical signs. Another important point in this case is that other identified Wegener’s patients were in their fourth or fifth decade of life; thus, Wegener’s was the last choice for a diagnosis in the current case.
Zahra Mohseni
Mohammadkarim Bahadori; Khalil Alimohammmadzadeh; Ramin Ravangard
Seyed Morteza Adyani; Ezzatollah Gol-Alizadeh
Abstract
International experience has shown that the increasing diversity in healthcare services precludes the integration of all services under a government health insurance plan in terms of performance and economy; no institution receiving a fixed amount of money per capita is able to provide all services. ...
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International experience has shown that the increasing diversity in healthcare services precludes the integration of all services under a government health insurance plan in terms of performance and economy; no institution receiving a fixed amount of money per capita is able to provide all services. Supplementary insurance is used in many countries.1 In Iran, comprehensive coverage of medical costs through a basic government medical insurance program is not possible because of the rising costs of diagnosis, use of more up-to-date and expensive medical technologies, and the development of new treatment methods. The number of people deprived of the right to healthcare is increasing daily. The structure of complementary insurance is based on participation and provides three types of coverage: completion of services, completion of costs, and integration of costs and services. In many leading countries, insurance is provided to a group with the participation of the insured and the insured’s employer who pays the employee’s premiums.
Reza Bidaki; Azadeh Rahavi; Farzaneh Dehghani; Mohamad Ebrahim Ghanei; Najmeh Zaer-Alhosseini; Maryam Khorasani
Abstract
Introduction: Carbon monoxide (CO) poisoning is a prevalent lethal condition. The clinical feature of this type of poisoning varies from headache and nausea to more severe conditions. After recovery from the acute intoxication, neurological or behavioral problems may emerge. In 3%-40% of cases, delayed ...
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Introduction: Carbon monoxide (CO) poisoning is a prevalent lethal condition. The clinical feature of this type of poisoning varies from headache and nausea to more severe conditions. After recovery from the acute intoxication, neurological or behavioral problems may emerge. In 3%-40% of cases, delayed neuropsychiatric syndrome (DNS) in post CO poisoning, generally develops within few weeks after a preliminary remission from acute poisoning. Case Presentation: We report a patient with relatively suitable premorbid. He was admitted to the hospital with fire burning, co poisoning and discharged home with good general conditions and mental status by receiving normal baric oxygen 100%. later in post-operative management of skin graft he developed a fulminant neurological deficit by impaired memory and concentration, loosening of association, disorientation to place, time and person, agitation, aggression, mood labiality, urinary incontinency and encopresis, slow psychomotor retardation, false and approximate answers to questions, auditory and visual hallucination, staring and inappropriate laughing. As the patient was not responsive to neurological treatment, he was referred to psychiatric service. DNS in this patient resolved gradually during a short period of psychopharmacotherapy and supportive psychotherapy. Conclusion: CO poisoning may lead to neuropsychiatric sequel and neuroimaging changes which could be reversible.
Moien Kardoust; Pouria Yazdian-Anari; Mostafa Nasiripour; Reza Bidaki
Abstract
Introduction: Diarrhea is one of the most common symptoms treated in general practice and gastroenterology. An estimated 1.7 billion cases of diarrhea are reported annually. Anxious and emotional persons are more sensitive to digestive problems. Anxious persons may feel their heartbeat and perceive their ...
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Introduction: Diarrhea is one of the most common symptoms treated in general practice and gastroenterology. An estimated 1.7 billion cases of diarrhea are reported annually. Anxious and emotional persons are more sensitive to digestive problems. Anxious persons may feel their heartbeat and perceive their intestinal motility and spasm, and this may cause them more concern. Case Presentation: In this case report, a 31-year-old woman with chronic diarrhea and a stressed psyche is presented so as to emphasize the combination of organ disorders and psychiatric moods. Conclusion: Patients suffering from chronic and persistence gastrointestinal disease should be evaluated by a psychiatrist. Psychotherapy and psych pharmacotherapy can greatly help the treatment of somatic complaints of these patients.
Sedigheh Mirhashemi; Mohammad Hosein Kalantar Motamedi; Amir Hossein Mirhashemi; Shaban Mehrvarz; Zahra Danial
Belinda Gousta; Mohsen Saberi Isfeedvajani
Abstract
Introduction: Homeopathy can be applied to treat various diseases and conditions such as cancer, allergy, mood disorders, headache and pain. This case showed that homeopathic medicine can be a treatment modality for idiopathic thrombocytopenic purpura (ITP), an autoimmune-mediated hematologic disorder. ...
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Introduction: Homeopathy can be applied to treat various diseases and conditions such as cancer, allergy, mood disorders, headache and pain. This case showed that homeopathic medicine can be a treatment modality for idiopathic thrombocytopenic purpura (ITP), an autoimmune-mediated hematologic disorder. Case Presentation: The patient was a 5.5–year-old child with ITP who referred to the homeopathic clinic with extensive petechiae and purpura on her body. Her platelet count was 15000/mcL and her anti-dsDNA and ANA were negative on her first visit. Her disease had first been diagnosed at the age of 2.5 years. She had undergone routine therapy for ITP; however, despite 15 months of corticosteroid therapy and IVIG injections, her platelet count was still low. After treatment with homeopathic remedies, her platelet count increased and signs of ITP disappeared. Conclusion: Homeopathic remedies can be considered as complementary and alternative medicines for ITP treatment protocols.
Narges Fakhari; Beheshteh Jebelli; Majid Marjani; Mohammad Varahram; Elham Ghazanchaei
Sohbat Rezaee; Manouchehr Avatef Fazeli; Arefeh Hedayati
Abstract
Introduction: Neurofibromas, benign peripheral nerve sheath tumors, are the most common among neural lesion. Neurofibromas are rare in head and neck location, although it may involve any part of oral cavity. However, tongue is the most common region.Case Presentation: A 27 year-old man was admitted to ...
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Introduction: Neurofibromas, benign peripheral nerve sheath tumors, are the most common among neural lesion. Neurofibromas are rare in head and neck location, although it may involve any part of oral cavity. However, tongue is the most common region.Case Presentation: A 27 year-old man was admitted to Otorhinolaryngology Department due to a swelling in the base of his tongue, since two weeks before. This mass was painless, and without any associated symptoms. He was suffered from a mild eating disorder, too. He had no any positive past medical history, and only a large soft 6 × 5 cm mass was found at the base of his tongue without bleeding in the oral cavity. Excisional biopsy was performed for him under general anesthesia and the tumor was easily enucleated. The final diagnosis was neurofibroma. After the diagnosis of neurofibroma, the physical reexamination revealed a series of café au lait spots on his skin.Conclusion: the neurofibroma should be considered by otorhinolaryngologist, as a differential diagnosis of tongue mass, and more accurate physical examination are recommended for better management.
Yaser Saeid; Mohammad Ali Sheikh Beig; Malihe Sadat Moayed