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Acute Brucellar pericarditis with cardiac tamponade without any concurrent cardiac lesion is an extremely rare manifestation . In this paper a 63 year old man is reported with brucellosis and massive pericardial effusion and tamponade . This case is very rare and there are finger count report of Brucella induced cardiac tamponade were in the international bibliography .

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Stent thrombosis as a complication of percutaneous coronary intervention frequently is associated with deadly events such as myocardial infarction and sudden death. Definitions of stent thrombosis have not been in a uniform manner in different clinical studies. Two episodes of acute ST elevation myocardial infarction nearly two years after implanting a drug – eluting stent in a 58-year-old male patient is reported here . The presence of stent thrombosis was confirmed by coronary angiography.

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Background and purpose: Clinical and radiological manifestations of Pulumonary tuberculosis are well known. However, it appears there is an increasing rate of unusual radiological patterns in immuno-competent adults, with smear positive pulmonary tuberculosis (based on our experience). The aim of this study was to analyze chest X-ray (CXR) findings and clinical patterns among immuno-competent men and women with smear positive pulmonary tuberculosis (TB) in Sari, Qaemshahr and Neka, during March 2006 to March of 2007.
Materials and methods: All new cases of pulmonary TB diagnosed during 12 months in 3 districts in Northern Iran, (Mazandaran Province) were included in a cross-sectional study. Inclusion criteria's were: positive smear of sputum and absence of any immuno-suppressive state. 65 cases fulfilled the inclusion criteria. Descriptive methods were used for data analysis.
Results: The common presenting symptoms were: coughing at 83%, hemoptysis at 24.6%, night sweating at 55%, anorexia at 60%, weight loss at 73.8 %, and fever at 60%. Usual radiological patterns was found in 70.8% of patients (upper lobe lesion with or without the remaining part) and incidence of an unusual radiographic pattern was 29.2%(middle and lower lob infiltration without upper lob lesion, milliary pattern, hilar lymphadenopathy and normal CXR).
Conclusion: This study showed that TB with atypical radiographic manifestations is more common than reported previously. These varieties of radiologic manifestations can mimic other disease entities. Therefore, recognition and understanding of radiologic manifestations and complication of tuberculosis are important to facilitate a diagnosis.

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Background and purpose: Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira. Pulmonary involvement is common in these patients but it often has few clinical symptoms. Ïn some cases however, pulmonary leptospirosis can develop a severe respiratory involvement with high mortality. The aim of this study was to investigate the frequency of lung involvement in leptospirotic patients.
Materials and methods: Ïn a cross-sectional study, the records of leptospirotic patients hospitalized in a third class hospital were investigated from Âpril 2009 to Âpril 2010. Leptospirosis diagnosis was done based on clinical symptoms and positive serology (ÏFÂ>1/180).
Results: Â total of 107 patients with confirmed leptospirosis were recruited in the study. Âmong them 64.7 % were males and 82.4% were farmers. The chief complaint in 105 patients was fever and in 2 was jaundice. Âmong the patients, 15.9% had abnormal chest X-ray and the most common radiographic finding was bilateral reticular infiltration. The mean age of patients with pulmonary involvement was significantly higher than that of the patients with normal chest X-ray (P<0.05), while no significant differences were found (P>0.05) between the two groups regarding their gender, occupation and laboratory findings (except ÇPK). The level of ÇPK was significantly higher in the patients with pulmonary involvement than in normal patients (P<0.05).
Çonclusion: Patients with leptospirosis can infrequently develop severe pulmonary involvement and respiratory symptoms and this involvement is mostly seen in higher ages.

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Background and purpose: Polycystic ovary syndrome (PCOS) can reduce body control and makes feeling of worthlessness, insecure, negative body image and consequently, makes a degree of despair, pessimism and low self-esteem. This study aimed to determining body esteem components in women with PCOS. Materials and methods: This study was done on 100 women with PCOS who were selected by consecutive sampling in Tehran, 2013. Data were collected by body esteem questionnaire and then analyzed using t student test. P < 0.05 was considered as a statistically significant level. Results: Total mean score and standard deviation (SD) of body esteem in PCOS women was 31.64 ± 3.51 and mean and SD of body esteem components was 2.57 ± 0.55 in sexual attractiveness, 7.54 ± 1.50 in being comfort with body, 11.11 ± 1.99 in own body comparison with healthy body, and 7.85 ± 1.64 in own and others ideas about sexual attractiveness. In case of all components scores and total score, there were no differences between fewer than 30 and 30 and over age's groups. Conclusion: Although it seems total score of body esteem in PCOS women is moderate and there are no differences between two age groups (under 30 and 30 years and more) regarding to body esteem, researches recommend further studies.

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Sinus of valsalva aneurysm, is a rare congenital defect and the diagnosis is usually made after it ruptures. The anomaly often involves the right coronary sinus and is less frequent in the noncoronary sinus. The rupture of the left sinus of valsalva into the pulmonary artery is extremely rare. So far, few cases with ruptured left sinus of valsalva have been reported. We are reporting a rupture of the left sinus of valsalva into the main pulmonary artery in a 15-year-old female diagnosed by transthoracic echocardiography.

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Myxoma is the most common type of primary tumors of heart. Recurrence of nonfamilial myxoma is unusual and recurrence in left atrial appendage is not reported. We present a case of sporadic myxoma in the left atrium who had a successful resection. However, the patient’s constitutional symptoms caused confusion and difficulty in diagnosis. Final diagnosis was recurrent Myxoma in the left atrial appendage which was made through echocardiography. Echocardiography is a standard choice for noninvasive diagnosis and localization of heart tumors. Operative resection of tumors is the most appropriate treatment for myxoma.

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Abstract Background and purpose: Recent studies showed that erythropoietin (EPO) despite having role in hematopoiesis, has non-hematopoietic tissue protective effects on ischemia-reperfusion injury. In this study we evaluated the effects of erythropoietin on reducing ischemia-reperfusion injuries after coronary artery bypass graft surgery (CABG). Materials and methods: 60 patients that was candidate for elective CABG randomly divided into two groups, EPO and control group. Patients in EPO group received IV infusion of EPO (700 IU/kg), at the start of reperfusion after aorta cross clamp. Cardiac markers: Troponin I and Creatine kinase MB (CKMB) assessed 8hours after CABG surgery. Also echocardiography was performed in all patients 6month after surgery. Results: Troponin I level had no difference in EPO and control group (P=0.30). CKMB level in EPO group was higher than control group (P=0.004). After 6month from surgery, Ejection fraction (EF) in EPO group was higher than control group but differences wasn’t significant (P=0.46). But Left ventricle end systolic diameter (P=0.017) and also Left ventricle end diastolic diameter (P= 0.04) in EPO group were significantly lesser than control group 6month after surgery Conclusion: in this study the administration of erythropoietin was associated with reduction in ischemia-reperfusion injuries by improving ventricular function, and also with reduction in myocardial remodeling and decrease in Left ventricle end systolic diameter and Left ventricle end diastolic diameter

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Isolated non compaction of left ventricular myocardium is a rare cardiomyopathy due to abnormalendomyocardialmorphogenesis. The incidence of non compaction cardiomyopathy in the general population has been estimated at 0.05% to 0.25% per year. NCCMP is a heart muscle disorder that is still little known among physicians and was first described in 1984 by engberding and bender. Echocardiography is diagnostic method of choice. We report our recent experience with six NCCM patients who present at our hospital between September2011and April 2012. Three patients were with severe symptoms, two patients with mild symptoms and one patient was asymptomatic.serial follow up and medical management is advisable in these patients for improving out come.

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Acute aortic dissection is a common disease caused by primary tear in the aortic intima or rupture of vasa vasorum. Every year 5-30 per million are affected by that. Untreated aortic dissection (dissecting aortic aneurysm) carries a high mortality rate. More than 90% of acute dissections present with acute pain in chest or back or both. Aortic dissection may mimic other more common conditions and high index of suspicion is required for prompt diagnosis and emergency treatment. In this paper, six patients with acute aortic dissection are presented who had atypical symptoms. Syncope, abdominal pain and diarrhea, dyspnea of exertion, severe weakness, faint and epigastric pain were chief presenting symptoms in these patients. Absence of severe chest pain has made the authors to present this study as case report. These cases signify the high clinical suspicion in diagnosis and treatment of aortic dissection. Furthermore, treatment of chronic hypertension is a strong modality in reducing the risks of aortic dissection

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Background and purpose: Breastfeeding is the best method of nutrition for infants and would lead to better somatic growth and neurologic development. It is an effective factor in decreasing infant morbidity and mortality. Inadequate breastfeeding results in complications such as failure to thrive, dehydration, uremia, azotemia and hypernatremia. The aim of this study was to assess the incidence of failure to thrive due to inadequate breastmilk intake. Materials and methods: This descriptive study was performed in 300 neonates born in Imam Khomeini Hospital in Sari, 2010. We compared the weight of the neonates at birth and by 7-10 days of age. Weight loss more than 10% was considered as failure to thrive. In this research SPSS V.13 was used to analyze the data. Results: From the total of 300 participants 20 (6.6%) neonates showed more than 10% weight loss in the first two weeks of life. The mean percentage of weight loss was 15.42 ± 6.24. Failure to thrive was statistically correlated with less than 34 weeks gestational age. The majority of mothers were not aware of their babies’ weight loss. In the course of the study two patients (0.7%) were severely dehydrated and admitted to the neonatal intensive care unit. Conclusion: In spite of instructions for breastfeeding shortly after delivery, failure to thrive occurs due to inadequate feeding in breastfed newborns. Therefore, early follow up of the breastfed mothers and neonates should be done to assess the weight gain in neonates.

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Background and purpose: We evaluated awareness of general practitioners (GP) of Mazandaran province to diagnosis, management and prevention of cholera Materials and methods: In a prospective study, 156 GPs answered to a questionnaire containing 15 questions in a face to face Interview. Sampling was randomly. Results: Sixty eight (43.6%) were female and 88 (56.4%) were male. The mean age of male was 42±7.8 years and female was 40±5.8 years. In total, awareness level of GPs about cholera was moderate in 89 (57.1%) and good in 48(30.8%). The awareness about diagnosis of cholera was good, moderate and poor in 23%, 69.9% and 7.1%, respectively. Also 17.3%, 71.8% and 10.9% of GPs had a good, moderate and poor (respectively) awareness of treatment. The awareness level of GPs about prevention of cholera was good, moderate and poor in 26.3%, 59% and 14.7%, respectively Conclusion: Given the moderate level of awareness of GPs about cholera, raises the need for more planning for control of epidemic.

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Probiotics are alive microorganisms which have useful effects on health of host by balancing its intestinal micro flora. Nowadays, probiotics are known as a factor for prevention of infectious diseases and cancer. Anti cancer properties of probiotics exert with the detoxification of materials that cause genetic damages. The present study aimed to systematically review on studies in checking positive effects of probiotics on health and their association with cancer. Related articles were searched in English at ACM, IEEE, Springer, Science Direct, Google Scholar, clinical trials and systematic review literatures that have assessed effects of probiotics at prevention and treatment of cancer, enrolled in this study. There was a wide variation among studies in imaging parameters, type of used probiotics, host type and test conditions. The results implied that probiotic bacteria and yeasts can eliminate toxicity of carcinogens and induce cancer cell death in vitro. In addition, consumption of probiotics caused reduced cancer risk, stimulation of immune system and struggle to carcinogens. Despite acceptable evidence about their anti-cancer properties, studies in humans are still limited. Therefore, there is a need to plan for detailed clinical studies on human in such a way obtained information can be used to treat.

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Background and purpose: Obstructive defecation syndrome (ODS) is a common dysfunction that affects adult female population. The Delorme’s procedure is a perineal approach for obstructed defecation syndrome. This study was designed to investigate the clinical outcomes after Delorme’s procedure for obstructed defecation syndrome. Material and methods: The study was carried out between June 2012 to October 2013 in which 22 patients with obstructed defecation syndrome had undergone Delorme’s procedure. Functional scores were measured and compared with preoperative scores. Results: The mean age of the patients was 51.1±16 years. The mean follow-up period was 10.6 months. The mean of longo score was 15.2±6.3 before the procedure and 3.1±2.9 after the procedure, which revealed statistically significant difference (P<0.0001). The mean of incontinence score was 3.3 and 0.9 before and after the Delorme’s procedure, respectively (P=0.002). Wexner constipation score revealed significant improvement after the surgery (11.3±5.2 before the surgery vs. 3.3±2.8 after the surgery P<0.0001). The mean of satisfaction score was 7.7±2. Conclusion: The Delorme’s procedure is a perineal technique that resolves obstructed defecation syndrome and is a low-risk surgery with less morbidity. The procedure is associated with a marked improvement in anal continence, relatively low relapse rates, and a low incidence of postoperative constipation. This shows that this procedure could be very beneficial in selected patients.

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Background and purpose: Transesophageal echocardiography (TEE) is established as a sensitive and accurate diagnostic method for the rapid assessment of cardiovascular diseases. It is believed that dexmedetomidine might be useful for sedating patients undergoing TEE. This study compared the use of dexmedetomidine and midazolam in patients undergoing TEE. Materials and methods: In a clinical trial, 48 patients undergoing TEE were randomly divided to receive either dexmedetomidine 1µg kg/i.v. over 10 min, followed by 0.2µg kg/i.v infusion, or midazolam 2 mg/i.v. Patients’ sedation level was determined according to Ramsay Sedation Scale, degree of analgesia, patients' satisfaction, arterial pressure, heart rate (HR) and readiness for discharge from recovery room. Results: Degree of analgesia, in the group receiving dexmedetomidine was found higher compared with that of the midazolam group (3.67±0.86 vs 0.83±0.56, P<0.001). The level of patients satisfaction with sedation was also higher in dexmedetomidine group (P=0.001). Readiness for discharge in the two groups were 7.08±1.17 and 3.71±1.57 min, respectively (P=0.001). Blood pressure and heart rate were similar in both groups. Conclusion: Our study suggests that compared to midazolam, dexmedetomidine is more suitable in sedation of patients undergoing TEE.

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Abstract Background and purpose: Spondylodiscitis is the infection of spine and disk caused by mycobacterium and brucella. The purpose of this study was to determine the clinical characteristics of patients with spondylodiscitis and having a correct diagnosis Materials and methods: A ten-year retrospective study of Spondylodiscitis was performed in patients with chronic tuberculosis and brucellosis (2004-2013) at teaching hospitals in Mazandaran province. Data was analyzed using descriptive and analytical tests in SPSS (ver. 16). Results: There were 54 individuals with spondylodiscitis amongst which brucellosis and tuberculosis were diagnosed in 22 and 32, respectively. The mean duration of illness was 2.40±1.48 months in brucellosis patients and 7.72±5.14 months in patients with tuberculosis (P<0.0001). Incidence of chilling and sweating in patients with brucellosis were 86.4% and 81.8%, which was significantly different from those of the cases with tuberculosis (P=0.001, P=0.005, respectively). Sclerotic lesions was detected in 54.5% of individuals with brucellosis spondylodiscitis and lytic lesions were seen in 81.3% of patients with tuberculosis spondylodiscitis, indicating a significant difference between the two groups (P=0.006). Conclusion: Some clinical signs (fever and sweating), radiological findings (lytic lesions of tuberculosis versus sclerotic lesions in brucellosis), and spines lesion can be helpful in making an accurate diagnosis.

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Background and purpose: Ischemic Heart Disease (IHD) is one of the most important complications of diabetes mellitus (DM). This study was designed to investigate the prevalence of IHD and related factors in patients with type II DM in north of Iran. Materials and methods: A cross sectional study was conducted in 1021 patients with diabetes type II attending endocrine clinics affiliated with Mazandaran University of Medical Sciences, Iran, 2010 to 2012. Age, gender, history of myocardial infarction, hypertension, hyperlipidemia, smoking and other recognized complications of DM were recorded. All patients were referred to cardiologist and the exercise test was used and if needed the thallium perfusion scan and coronary angiography were done for patients without history of myocardial infarction,coronary artery bypass surgery or stent placement. Results: There were 1021 patients and 907 were female (88.8%). Mean age and duration of diabetes were 54.4 (95% CI: 53.8- 55.1) and 8.8 (95% CI: 8.4 - 9.2) years, respectively. Almost 87% (95% CI: 85-89) and 53% (95% CI: 50-56) had dyslipidemia and hypertension, respectively. Among the patients, 274 patients (37% males and 25% females, 26.8% 95% CI: 24.1-29.5) were suffering from IHD (P =0.006). According to regression logistic analysis duration of diabetes, older age, hypertension, and low left ventricular ejection fraction were independent predictor factors for IHD. Conclusion: Approximately one-third of diabetic patients are suffering from IHD. This disorder can be asymptomatic in individuals with diabetes, therefore, it may not be diagnosed in almost half of patients. Most important associated factors are older age, duration of diabetes, hypertension and low left ventricular ejection fraction.

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Background and purpose: Infection is one of the most important complications after coronary artery bypass surgery. The purpose of this study was to evaluate the risk factors for infection in these patients.

Materials and methods: A descriptive prospective study was performed in 986 patients hospitalized in Sari Fatemeh Zahra hospital, Iran 2014-2015. Possible risk factors for infection (before, during and after the surgery) were recorded. Patients were followed up for possible infection until 30 days after surgery. Data was analyzed in SPSS applying t-test and Chi-Square. The p value less than .05 was considered significant.

Results: Totally, 52 patients (5.3%) developed infection including sepsis (28.8%), pneumonia (17.7%), mediastinitis (15.3%) and deep incisional surgical site infection (11.5%). Significant associations were found between developing infection following coronary artery bypass and prolonged use of Foley catheter, the balloon inside the artery during surgery, using internal mammary artery as a graft, left ventricular outputs, high blood pressure in the morning of surgery, days of hospitalization before and after the surgery, duration of intubation after surgery, duration of ICU stay, duration of bypass surgery, high BMI, and reoperation following complications (P> 0.05).

Conclusion: In this study, the risk factors during and after the surgery were more responsible for infection after coronary artery bypass surgery compared to preoperative conditions.

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The H1N1 virus is one of the highly contagious strains that leads to epidemic influenza every year in winter. In this outbreak sometimes rare complications of this infection occur.  This report presents a rare case of encephalitis caused by H1N1 virus in a 52-year old man. After a day fever and flu like symptoms the patient was admitted in hospital due to decreased level of consciousness. Brain CT was found to be normal and since it was the flu season empiric treatment with vancomycin, ceftriaxone, acyclovir, and Tamiflu was started. In third day of treatment the patient was alert and had no brain dysfunction. CSF samples were positive for H1N1. Staining and culture were negative for CSF and ten lymphocytes were found in CSF samples, also protein and sugar levels were in normal ranges. The patient with encephalopathy associated influenza was treated with Tamiflu within 10 days and he was discharged in good condition. It is noteworthy that influenza can cause loss of consciousness due to encephalitis or meningoencephalitis, especially during influenza season.

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Background and purpose: Human leptospirosis is prevalent and endemic in north of Iran, especially in Guilan and Mazandaran provinces as temperate regions. The purpose of this study was to survey the epidemiologic and sero-prevalence nature of leptospirosis in healthy people in Mazandaran province.

Materials and methods: A cross sectional study was carried out in three rural regions in Ghaemshahr, Iran, 2015. The participants included 272 paddy field workers who were selected via convenience sampling. Demographic information was recorded and serum samples were tested for anti-leptospiral IgG antibodies.

Results: The subjects were 184 (67.5%) males and 88 (32.5%) females. There were 265 (98.1%) farmers and 284 (93.4%) worked in paddy fields. Positive anti-Leptospira IgG (> 0.3) was observed in 49 cases (18%).  Significant association was found between working in paddy fields and serology test results (P=0.043). But there was no significant relation between age, gender and exposure to animal and positive serology (P=0.699, P=0.32, P=0.092, respectively).

Conclusion: High sero-positivity, high number of people working in paddy fields and ecologic conditions of the province calls for appropriate training programs for farm workers such as wearing standard shoe covers in the hope that leptospirosis is controlled.