Primary infradiafragmatic bony classical Hodgkin lymphoma

Infradiaphragmatic Hodgkin’s lymphoma (IDHL) is a scarce neoplasm and primary pelvic bone exhibition is limited to case reports. Recognition and management of likewise a rare disease are challenging. Here the authors present a peculiar case of classic Hodgkin lymphoma (CHL) of pelvic bone. A 31year-old man was admitted to our hospital with chief complaint of left hip pain. Imaging showed a lytic lesion in the left iliac bone with sclerotic margin and extension to soft tissue. Open biopsy confirmed the diagnosis of CHL. CHL at first introducing as pelvic bone involvement is really uncommon. The diagnosis of primary bone CHL should be made by tough histological and clinical expression.

Extended erythrocyte and reticulocyte parameters in the diagnosis of iron deficiency in hemodialysis patients

Objective: Iron deficiency (ID) is a frequent complication in end stage renal insufficiency. These patients have to be diagnosed and treated to reduce the prevalence of anemia. Functional iron deficiency (FID) is a situation that can disrupt biochemical iron tests and mask an eventual association with ID. In this study, we tried to prove the ability of extended parameters of red cells and reticulocytes to diagnose ID without being influenced by FID. Design and methods: 164 chronic hemodialysis patients (CHP) in end stage renal disease were enrolled. Research parameters of red cells and reticulocytes determined on ADVIA 2120i were studied in the diagnosis of ID associated or not with chronic inflammation. Results: Parameters such as corpuscular hemoglobin of mature red cells (CHm), corpuscular hemoglobin of reticulocytes (CHr), cellular concentration of hemoglobin in mature red cells (CHCMm), cellular concentration of hemoglobin in reticulocytes (CHCMr) and percentage of microcytic and hypochromic red cells (HYMI) showed a high sensitivity to diagnose ID. However, the distinction of combined iron deficiency (CID) from other entities was not possible with all parameters. In chronic inflammatory states, the decrease of CHm, CHCMm and CHCMr with the rise of percentage hypochromic mature red cells (HYPOm) and reticulocytes (HYPOr) is in favor of CID. So, determination of inflammatory state is needed to complete research parameters of blood count in CHP. Conclusion: Extended erythrocyte and reticulocyte parameters can be useful to check iron status in CHP.

A developing brain abscess as acute stroke mimic: presentation of case and review of literature

Whether brain abscess is a cause, or a complication of stroke has been a question that elicited differing opinions. We report a case of a child who initially presented with hemiparesis and seizures. Initial brain tomography did not show hemorrhage or infarction. He was managed as a case of childhood stroke. The neurologic manifestations gradually improved until the 17th day of hospitalization when regression of the motor strength and anisocoria occurred. A repeat brain tomography showed multiple masses and vasogenic edema consistent with brain abscess.

The Immediate Effects of Pulse Steroid versus Common Steroid therapy in Patients with SSNHL

Introduction: In this study we aimed to review immediate effects of pulse steroid therapy versus common steroid therapy in patients with idiopathic Sudden Sensory- Neural Hearing Loss. Materials and Methods: In this clinical trial study 50 patients with SSNHL in less than 24 hours before referral were involved. The causes of hearing loss should be rejected and if the cause was identified, the patient would be excluded. Pulse therapy group received Methyl Prednisolone 10 mg /kg for three days and then continued by prednisolone 1 mg /kg for ten days and common therapy group received prednisolone 1 mg /kg for ten days. Average hearing threshold of the patients in frequencies of 500, 1000, and 2000 Htz, average SDS of patients and patient recovery was compared between two groups based on hearing tests and guidelines. Results: Fifty patients with average of 46 ±15.69 years were studied. There was no significant difference in average of hearing threshold in different frequencies and SDS between two groups. Mean hearing recovery was 10.69 db in common steroid group and it was 13.51 db in pulse steroid group. Although the mean of hearing recovery was higher in the pulse steroid group compare the common steroid group, there was no significant difference in hearing recovery after the treatment between two groups. Conclusion: According to the results pulse steroid is not preferable rather than common steroid therapy in terms of immediate therapeutic effects on SSNHL.

Myopia: Efficacy of 1% Atropine in Retarding Progression

Purpose: To determine the efficacy of 1% atropine eye drops in control of myopia progression. Methods: This was a Case control study, conducted at the Mohsin Family Health Clinic, Block-16, Federal B Area, Karachi, during January 2018 to December 2019. A total of 194 (97 cases and 97 controls) cases were included in the study by the calculation of online software openepi.com. The Treatment Group was given 1% atropine eye drops while Control Group received no treatment. The follow-up of all the cases was carried out according to the follow-up schedule for a total period of one year. All the demographic data, clinical findings and the follow-up results were recorded on a proforma designed for the study, and the results were tabulated. Results: A total of 194 children age 6-15 with best corrected visual acuity 6/6 were recruited in this study. Half of the children were included in treatment group who received once a day application of 1% atropine eye drops at bedtime. The other half received no treatment and were taken as control group. Mean spherical equivalent refraction (SER) at baseline was 2.93±0.69 of Treatment Group and 2.98±0.61 of control group with insignificant P-value of 0.461. After 1-year treatment statistically significant difference with P-value 0.001, was observed with SER 3.37±0.91 in Treatment Group and 3.69±0.94 in control group. Conclusion: Atropine 1% eye drops is well tolerated and is found efficacious in controlling myopia progression.

The most common infections leading to hospitalization in educational- research hospital of Yazd

Infectious diseases are one of the diseases that are generally better suited to diagnostic and antibiotic treatments. However, there is significant mortality in infectious diseases. This study was done to determine the infection leading to admission. This study was performed on hospital data. All patients admitted in Shahid Sadoughi hospital in Yazd province in one year were studied. The final diagnosis is based on symptoms and clinical infectious disease by a specialist. Data were analyzed by statistical software SPSS and Chi-square tests. In the time period examined, 1326 patients were enrolled, 56.7% were male and 43.3% female that age range were 14-95 years. The most commonly reported illness at the time of hospital discharge was pneumonia (16.7%), UTI (11.2%), diabetic foot ulcer and cellulite (13.7%). There was a significant relationship between the most commonly diagnosed illnesses age and gender at the onset and discharge of patients (P value<0.05). It is worth noting that cases without diagnosis were 20.1% and in the elderly group with a population of 53.6% of the total hospitalized patients, pneumonia and UTI were the most common complications. The present study has shown that pneumonia is the most prevalent among the causes of hospitalization among the elderly and non-elderly patients in the infectious part, and there is a significant relationship between age and sex and the prevalence of disease in patients were in Hospital.

A Retrospective study on the dynamics of the clinical and Demographical evolution of Cutaneous Leishmaniasis in the Yazd province, Iran

Leishmaniasis is considered as an important health problem in the world. Cutaneous Leishmaniasis is epidemic in all of places of Iran, this disease begins as small swells and then they gradually grow and turn into wounds. Since the epidemiological study of this problem is effective in preventing and controlling it. The current research was conducted to study the epidemiological study of Cutaneous Leishmaniasis in Yazd province during the past 5(2014-2018) years. This cross-sectional study has been conducted on registered information and documents of the patients having problem in Yazd province remedial and health care centers over the past 5 years. First, the registered demographic and epidemiological data of the patients were extracted and then they were analyzed by using SPSS 18 software with chi-square test and descriptive statistics.897 patients included 457 males (51.06%) and 439 females (48.94%). The majority of the patients were between nine 20-29 years old and the minority of them were over the range of 5-9 years old. Most lesions were on the hand and leg of the patients. It was also found that there was a significant relationship between age groups and types of Leishmaniasis (P<0.05) as well as gender and type Leishmaniasis (P<0.05). According to our study, there has been an ascending trend in disease frequency in Yazd province from 2014 to 2018. This increase in diseases due to lack of health and educational status of the people-is also a lack of personal hygiene.

The Pivotal Role of Lifestyle Medicine Physician in Managing Chronic Diseases

Background: Chronic diseases are presently the leading cause of morbidity and mortality and are responsible for most of health care expenditure, both in wealthiest countries and those with limited resources. Aims and Objectives: To ratify the competence of skill set Lifestyle Medicine Physician in identifying multiple factors tied to individual’s health. Study Design: To define the attributes of a Lifestyle Medicine Physician. Material and Methods: The role of the Lifestyle Medicine Physician in introducing meaningful, measurable, attainable and sustainable lifestyle interventions which are acceptable, doable and enjoyable for the target group, has been described. In addition the important effect of Spirituality, in the context of the Palliative Care Guidelines of the World Health Assembly and on the increasing toll of Physician Burnout, has been highlighted. Results: Implementation of lifestyle recommendations, under the guidance of Lifestyle Medicine Physician, can significantly reduce premature disability and mortality. Conclusion: The skill set physicians who, with strong basic knowledge, would be able to identify the multiple factors tied to individual ‘s health, provide individualized advice and succefully change menance of chronic lifestyle-related diseases.

Dengue-triggered Hemophagocytic lymphohistiocytosis in an adolescent with autoimmune thyroiditis

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a life threatening hyperinflammatory hematological syndrome characterized by cytokine storm and the diagnosis can be missed as it mimics sepsis or multi-organ dysfunction syndrome. Case Report: A 15-year old adolescent girl presented with six-day history of high grade intermittent fever with easy fatigability and dyspnea on exertion. She was found to have severe anemia elsewhere (Hemoglobin- 4 g/dl, normal 11-16.5 g/dl) and referred to our hospital due to persistent fever, tiredness and recurrent vomiting. On examination she was pale and febrile. Her blood investigations revealed moderate anemia, leukopenia and markedly elevated liver transaminases with coagulopathy. Dengue NS1 antigen and IgM antibodies were positive suggestive of acute dengue infection. Further workup revealed markedly elevated serum ferritin (37973 ng/ml, normal 10-120 ng/ml) and lactate dehydrogenase levels (5311 U/L, normal 180-360 U/L). Plasma fibrinogen level was low (164 mg/dl, normal 200-400 mg/dl). Bone marrow biopsy done on day 3 revealed hemophagocytosis. Serum TSH was mildly elevated (6.5 mU/L, normal 3.5-5 mU/L) and anti-thyroid peroxidase (TPO) antibodies (68 IU/ml, normal <5.6 IU/ml) were also significantly elevated. Diagnosis of Hemophagocytic lymphohistiocytosis (HLH) secondary to dengue infection and autoimmune thyroiditis was made. She was treated with dexamethasone 10 mg/m2 /day from day 3 of admission along with supportive treatment. She rapidly improved and her laboratory parameters returned back to normal at 1 week of follow up. Conclusion: Dengue fever with unexplained severe anemia in the absence of bleeding should be evaluated for HLH as timely initiation of treatment will be life saving

Evaluation of antibiotic use pattern in Shahid Sadoughi hospital of Yazd

Antibiotics are a class of drugs that are widely used to eliminate the causes of many infectious diseases around the world. It should be borne in mind that their irrational and irregular administration will increase bacterial resistance and dangerous complications. For this reason, timely diagnosis and usage of antibiotics is one of the tasks of physicians to improve the patient's use of the lowest number of antibiotics. This was a retrospective descriptive cross-sectional study. The samples were selected by non-random sampling from all records of patients admitted to Shahid Sadoughi Hospital of Yazd from HIS hospital system with total number of 82742. The type of hospital admission, the type of prescription, the cause of antibiotic prescription, the cost of antibiotic use was entered into the questionnaire. The most commonly used antibiotics were cefazolin with a frequency of 18.41%, clindamycin with a frequency of 17.49%, ceftriaxone with a frequency of 15.48% and vancomycin with a frequency of 10.18% and metronidazole with a frequency of 7%, respectively. The most costly antibiotics were meropenem (14.28% of costs), vancomycin (13.4%), and amphotericin (10.09%). The pattern of antibiotic use in hospitals should be more carefully considered and given the cost and burden of unnecessary antibiotic use, serious consideration should be given to antibiotic use.