The GEB is a useful aid to nasotracheal intubation, reducing bleeding, the requirement for Magill forceps and, to a small degree, intubation time. A case exists for its routine use for this purpose.
Introduction: Ecthyma gangrenosum is a skin lesion presenting invasive infection in the skin, which is commonly caused by Pseudomonas. Pathogenesis is mostly attributed to the microbial invasion in cutaneous tissues caused by the microorganism. One of the important, but rare causes of Ecthyma gangrenosum after Pseudomonas is Escherichia coli. Case Presentation: A 45-year-old woman known as a case with acute myeloid leukemia who went into remission due to chemotherapy. After chemotherapy, she was febrile and septic. A physical examination revealed an erythematous round lesion (3 × 3 cm) that had developed on the posterior aspect of the right thigh with central bolus necrosis. E. coli was detected based on both blood cultures. Conclusions: Ecthyma gangrenosum is mostly seen in patients with severe immunodeficiency such as aplastic anemia, hematologic malignancies, especially patients with leukemia after chemotherapy and also in HIV patients. So far, in 11 patients reported in the literature, at least 8 cases are reported lesions on the lower limb, which is the most probable anatomic area for E. coli-induced Ecthyma gangrenosum. The E. coli-induced Ecthyma gangrenosum is a rare infectious lesion that is particularly seen in patients with a malignancy history, and lower extremity lesions should be considered.
Introduction: The aim of this study was to determine the prevalence of exposure to hepatitis A by means of serologic markers in chronic hepatitis B patients, with the secondary aim of finding the best prevention method for hepatitis A infection in susceptible groups of our setting. Methodology: During the period between 2016 and 2017, we recruited 403 hepatitis B patients aged more than 14 years and regularly attending the infectious diseases clinic at a referral university hospital, Tehran, Iran. A blood sample was collected from all the patients and tested for hepatitis A IgG. The data was analyzed by SPSS v.19. Results: Although none of the patients had previously received hepatitis A vaccine, the results for serologic level of hepatitis A IgG, demonstrated positive results in 379 (94%) cases. The mean age of patients with negative and positive IgG was 29.17 and 42.46 years, respectively; the difference was statistically significant (P≤0.001). The majority of seronegative patients were young adults aged < 25 years and 25 to 35 years (P <0.001). Discussion: Considering the high seroprevalence of hepatitis A in chronic hepatitis B patients in Iran, particularly in patients younger than 35 years old, the immunization for seronegative hepatitis B patients is strongly recommended.
Objective. To investigate the predictive factors of residual pulmonary opacity on midterm follow-up CT scans in patients hospitalized with COVID-19 pneumonia. Materials and Methods. This prospective study was conducted in a tertiary referral university hospital in Iran, from March 2020 to December 2020. Patients hospitalized due to novel coronavirus pneumonia with bilateral pulmonary involvement in the first CT scan were included and underwent an 8-week follow-up CT scan. Pulmonary involvement (PI) severity was assessed using a 25-scale semiquantitative scoring system. Density of opacities was recorded using the Hounsfield unit (HU). Results. The chest CT scans of 50 participants (mean age = 54.4 ± 14.2 years, 72% male) were reviewed, among whom 8 (16%) had residual findings on follow-up CT scans. The most common residual findings were faint ground-glass opacities (GGOs) (14%); fibrotic-like changes were observed in 2 (4%) patients. Demographic findings, underlying disease, and laboratory findings did not show significant association with remaining pulmonary opacities. The total PI score was significantly higher in participants with remaining parenchymal involvement (14.5 ± 6.5 versus 10.2 ± 3.7; P = 0.02 ). On admission, the HU of patients with remaining opacities was significantly higher (−239.8 ± 107.6 versus −344.0 ± 157.4; P = 0.01 ). Remaining pulmonary findings were more frequently detected in patients who had received antivirals, steroid pulse, or IVIG treatments ( P = 0.02 , 0.02, and 0.001, respectively). Only the PI score remained statistically significant in multivariate logistic regression with 88.1% accuracy (OR = 1.2 [1.01–1.53]; P = 0.03 ). Conclusion. Pulmonary opacities are more likely to persist in midterm follow-up CT scans in patients with severe initial pulmonary involvement.
Essential thrombocytosis is a myeloproliferative disease of unknown reason that causes progressive platelet overproduction, which this high counts of platelets appear to be associated with intravascular thrombosis and related event. There are several medications to prevent thrombosis formation in these patients, such as hydroxyurea, and aspirin. We do not have much information about the duration of the medication. Our case was a 28-year-old woman without any history of medical problem, who gave birth recently, presented to the emergency department with epigastric abdominal pain, nausea/vomiting, loss of appetite, chills and diarrhea. On initial examination, huge splenomegaly about 20 cm below the edge of the ribs in the midclavicular line were detected. All lab data were within normal ranges. Pregnancy behaves as a trigger for undiagnosed essential thrombosis in this patient. She underwent anticoagulant therapy which still continuous. It seems that pregnancy became a triggering factor for ET in our case to show up with the symptoms like thrombosis. There is lack of evidence about duration of treatment. We don't know when we should stop the anticoagulant therapy or we should continue the medications lifelong. This issue should be considered as the basis of future studies.
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