Epidemiological, molecular characterization and risk factors of human brucellosis in Iran

Objective:To determine epidemiological,molecular characterization,and potential risk factors of human brucellosis.Methods:This descriptive study was carried out in the clinical setting in Iran between 2017 and 2018.A total of 297 participants enrolled in the study.The sample size was calculated based on the occurrence rate of brucellosis in different areas.Patients were assessed using serological tests and conventional culture methods.Phage and multiplex PCR methods typed all of Brucella isolates.Potential risk factors of disease were determined.Results:A total of 141 of 297(47.5%)Brucella strains were isolated and all of them were detected as Brucella melitensis biovar 1.Based on serologic titers,high culture positivity was recorded at 1/640 titer(P<0.006).The risk factors for brucellosis were patients older than 40 years(OR=2.23,95%CI:1.4-3.55,P=0.001),animal keeper(OR=7,95%CI:1.51-32.41,P=0.005),housewife(OR=8.76,95%CI:1.85-41.37,P=0.002),farmer(OR=6.42,95%CI:1.21-33.97,P=0.019),and contact with animal(OR=1.31,95%CI:0.60-2.85,P=0.005).Conclusions:To the best of our knowledge,this is the first comprehensive report from Iran presenting the detection of Brucella species by the multiplex PCR.Brucella melitensis biovar 1 is still the dominant causative agent in Iran.The consumption of unpasteurized dairy products,living in rural areas,and animal contact were risk factors of brucellosis.

Quantification of the Erythropoietic Response to Anemia and Determination of the Hb ×log(Epo) Component as an Independent Parameter, Indicating the Response to Hypoxic Stress

Serum erythropoietin (Epo) levels are influenced by the integrity of renal function, the severity and etiology of anemia, the percentage of hemoglobin F and other factors. We aimed to create a parametric expression for the response to anemic/hypoxic stress and we evaluated serum Epo levels in 1096 subjects with normal renal function, of whom 837 were anemic (Hb 16.5 g/dl). Hb ranged between 3.6 and 23.8 g/dl and the corresponding Epo between <3.4 and 2670 mIU/ml. Between log-Epo and Hb the correlation co-efficient r was ?0.706. The function linking Hb and log-Epo was determined as log(Epo) = 3.05 - 0.131 × Hb. Investigating various mathematic models, which could parametrically express the “response to anemia/hypoxia”, we found that the Hb × log(Epo) product was a stable parameter and fitted a normal distribution. Arbitrarily defining as normal range about one SD between the mean (12 - 21) we found that only 224 patients (20.8%) exhibited a Response to Anemia Index (RAI) beyond these limits. Below the lower limit there were 106 patients, diagnosed with polycythemia vera (12/38, 31.6%) anemia of chronic disease (10/34, 29.4%), megaloblastic anemia (17/56, 30.4%) and β-thalassemia trait (11/41, 26.8%). Forty-eight patients (45.3%) were diabetic. Above the defined upper normal RAI limit there were 118 patients, mainly diagnosed with secondary erythrocytosis (24/34, 70.6%), aplastic anemia (8/20, 40%), hemolytic anemia (3/14, 21.4%) and myelodysplastic syndromes (46/326, 14.1%). RAI was a rather constant parameter for each individual, with minimal variation in different evaluations, when Epo was estimated in the absence of inflammatory conditions. We have validated the superiority of RAI for the prediction of response to Epo in a cohort of 669 patients, who received Epo treatment. It is concluded that RAI is a reliable parameter describing the response to hypoxic/anemic stress.

Higher Energy Does Not Mean Better Outcome Following Endovenous Laser Ablation of Great Saphenous Vein

Background: Endovenous laser ablation is a relatively newer alternative to treat great saphenous vein insufficiency. We evaluated the efficiency and safety of treatment endovenous laser procedures on the different saphenous vein diameters with different energy levels. Methods: Data regarding endovenous laser ablation of symptomatic chronic great saphenous venous insufficiency in 209 patients were prospectively recorded. Patients were grouped into two main groups based on their diameters as 5 to 7 millimeters (Group A) or more than 7 millimeters (Group B). Patients in each group was randomized into two groups as >90 J/cm (A1 and B1) or 80-90 J/cm (A2 and B2). Postoperative outcome and complications were recorded during follow-ups at 1st week;1st, 3rd and 6th months to examine the venous reflux and recanalization. Results: Perioperative complaints as pain, cramps and ankle swelling were more commonly observed in A1 group. Fatigue was more common in A2 and B2 groups. No major complications as deep vein thrombosis or skin burns were observed. Conclusions: Endovenous laser ablation is a safe and effective procedure with a high satisfaction rate shortening hospitalization durations and early ambulant activity. Pain, ankle swelling and fatigue are the most common minor complaints in the early postoperative period.

Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis

background While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively,the prevalence,natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis(ISBAS)remain unknown.Methods We reviewed our prospective institutional database to identify patients with≥50% symptomatic basilar artery(BA)stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries.Stroke mechanism,collateral circulation,and degree and length of stenosis were analysed.The primary outcome was time from index event to new transient ischaemic attack(TIA),acute ischaemic stroke(AIS)or death.Other outcome variables included modified Rankin Scale(mRS)score on discharge and last follow-up.results Of 6369 patients with AIS/TIA,91(1.43%)had ISBAS.Seventy-three(80.2%)patients presented with AIS and 18(19.8%)with TIA.Twenty-nine(31.9%)were women and the median age was 66.8±13.6 years.The mean follow-up time was 2.7 years.The most common stroke mechanism was artery-to artery thromboembolism(45.2%),followed by perforator occlusion(28.7%)and flow-dependent/hypoperfusion(15.1%).The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3-6 on discharge(78.3±14.3 vs 86.9±14.5,p=0.007).Kaplan-Meier curves showed higher recurrence/death rates in patients with≥80% stenosis,mid-basilar location and poor collateral circulation.Approximately 13% of patients with ISBAS presented with complete BA occlusion.Conclusion ISBAS is an uncommon(1.43%)cause of TIA and AIS.Men in their 60s are mostly affected,and artery-to artery embolism is the most common stroke mechanism.Mid-basilar location,≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis.