Internal Medicine and Medical Investigation Journal (IMMINV)
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Conservative Treatment of Huge Retroperitoneal Hematoma Postpartum: Case Report
No full textIntroduction: Retroperitoneal hematoma are an important factor for hospitalization in patients with trauma and proper treatment is still under discussion and Controversial. We describe a successful case of conservative treatment of huge hematoma after cesarean section. Case presentation: An Iranian 34-year-old multigravida(G4L3) woman with three previous cesarean sections from Urmia province presented to our hospital with amniotic fluid leak. She had full-term pregnancy. Caesarean section was done. One day after caesarean section, she became dyspnea and had chest pain in left side. Embolism is suspected and enoxaparin was administered. According, hemoglobin decreased (HB:6.2) after administered the second dose of enoxaparin and a clear dullness percussion led tosuspected to hemorrhage and retroperitoneal hematoma was discontinued enoxaparin. After the patient is stable, the patient was discharged and retroperitoneal hematoma was followed up by ultrasonography and conservative treatment. Conclusion: Conservative treatment of retroperitoneal hematoma postpartum with good clinical evolution, depends on status of the patient, cause of injury and its evolution
Ruptured Aneurysm of Sinus of the Valsalva: Case Series
Full text linkIntroduction: We present three cases of ruptured sinus of Valsalva aneurysm concomitant with a cardiac lesion in 2 cases of ventricular septal defect and 1 case of bicuspid aortic valve with mild aortic insufficiency. Case presentation: In 2/3 cases, the site of ruptured sinus of Valsalva aneurysm originated from right coronary cusps and one from non-coronary cusps. Both ruptured sinus of Valsalva aneurysm from right coronary cusps communicated to right ventricle, and one that originated from non-coronary cusps ruptured to right atrium. All cases were diagnosed by transthoracic echocardiography and confirmed by transesophageal echocardiography. Two underwent the surgery, while one did not want to continue treatment. Conclusion: ruptured sinus of Valsalva aneurysm is a rare cardiac anomaly. In the Eastern countries, the most common associated anomalies with ruptured sinus of Valsalva aneurysm are ventricular septal defect and aortic regurgitation. Ruptured sinus of Valsalva aneurysm mainly originates from right coronary cusps and is ruptured into right ventricle. Transthoracic echocardiography and transesophageal echocardiography are employed to confirm the diagnosis. In this cohort, the coexistences of ruptured sinus of Valsalva aneurysm with ventricular septal defect and aortic regurgitation (case 1), ventricular septal defect (case 2), aortic regurgitation and bicuspid aortic valve (case 3) are observed
Risk Evaluation of Loss in Professional Efficiency, Health, and Work Safety Using Psychophysiological Factors
Full text linkIntroduction: A transformation in modern production and an increase in workload requires an improvement in the occupational psychophysiological selection, the search for new approaches for its implementation, and the creation of special ways for the evaluation of the psychophysiological state of workers. The aim of this investigation is to develop an approach for the quantitative evaluation of the efficient reduction in risk in worker’s occupational activity, and the probability of health and safety depletion during the entire life period of work. Materials and Methods: The investigation is based on the data of 110 psychophysiological indicators, received from a survey that encompassed the workers of operative service in electric power engineering industry of Ukraine. The data was examined using statistical tools, factor analysis, and multivariate regression models. Results: The developed technique made it possible to determine the statistical significance and to estimate the impact of the important phychophysiological factors on the level of success in the occupational activity of workers under dangerous circumstances. The model includes the variable that describes the age of the worker and provides analysis for 4 categories of ages. Conclusion: The important factors that influence the risk of reduction in occupational efficiency of the workers are variability, the total error, and the number of positive values according to the pendulum methodology; the average reaction time according to the square-circle technique; variability according to the square technique; and adaptability and time of the task performance according to the adaptability methodology. The workers belonging to the same age group do not significantly change the risk of depletion in their occupational efficiency
Corroboration of Spiral CT angiography with D-dimer Assays in the accurate diagnosis of Pulmonary Embolism with assessment of its Image quality
No full textIntroduction:
Pulmonary embolism is a frequent cause of mortality and morbidity. Aim of this study was to evaluate the utility of spiral computed tomographic angiography in determining the prevalence of pulmonary embolism in a clinically suspicious group and to assess the image quality of a single source computed tomography in diagnosis of pulmonary embolism. We have also investigated the reliability of D-dimer test in ruling out pulmonary embolism.
Materials and Methods:
50 patients clinically suspected of having pulmonary embolism were examined with contrast-enhanced spiral computed tomography in the hospital affiliated to Zhengzhou University from August 2014 to December 2015.
Image quality, was assessed by analyzing the attenuation in the pulmonary trunk and its branches in comparison with the background noise. Mean attenuation values and standard deviation were recorded and displayed in Hounsfield Units. The computed tomography values, standard deviation values and signal-noise ratio obtained were then statistically analyzed using SPSS 17.0 software.
D-dimer test results were also obtained for the patients suspected of pulmonary embolism using rapid D-dimer testing and a reference range of 0–0.3 µg/l was considered as normal.
Results:
Spiral computed tomography was a valuable method for identifying 20 patients with pulmonary embolism (sensitivity, 100%). It could correctly exclude pulmonary embolism in 28 out of 30 non - pulmonary embolism cases yielding a specificity of 94%.In 10 of the 20 patients devoid of pulmonary embolism; Spiral computed tomography provided an alternate clinical diagnosis. In the remaining 10 patients, spiral computed tomographic angiography scans were normal. The statistical analysis of the computed tomography values standard deviation and signal-noise ratio of the pulmonary trunk and pulmonary artery (without right or left predilection) showed a p-value>0.05. D-dimer Test showed elevated levels in 18 patients who were diagnosed with pulmonary embolism on spiral computed tomography scans. 8 patients without pulmonary embolism on spiral computed tomography scans also showed elevated D-dimer levels. The remaining 22 patients had normal D-dimer levels.
Conclusion:
Spiral computed tomography has a good sensitivity and specificity for the diagnosis of pulmonary embolism. In the majority of patients who did not have pulmonary embolism, it provided important ancillary information for the final diagnosis.
Therefore, combining Spiral computed tomography scan with a D-dimer Test is more effective in the accurate diagnosis of pulmonary embolism
Pancreatic Involvement in Hermansky–Pudlak Syndrome- A Case Report
Full text linkHermansky-Pudlak Syndrome (HPS) is a rare autosomal recessive disorder that presents with oculocutaneous albinism, bleeding disorders, and immunodeficiency. Granulomatous colitis and pulmonary fibrosis are two major complications of this syndrome. On rare instances, HPS can involve the heart and lungs. This report discusses a 32-year-old man who presented with oculocutaneous albinism and immunodeficiency along with renal, pulmonary, and pancreatic complications. Pancreatic atrophy is a unique finding in our patient, which has not been reported in the literature. The purpose of our case report is to bring into light unusual complications of HPS so that timely action could be taken to avoid the progression of complications. 
Pyomyositis: A Complicated and Curious Case Report
Full text linkIntroduction: In the elderly (over the age of 50), the risk of urinary tract infections is estimated at 8% per year in men. Anatomic abnormalities such as prostatic hypertrophy, leading to urinary retention is considered as the main reason. Pyomyositis is an uncommon condition of optical urethrotomy, especially in patients who have received local radiation therapy in the past. Till date no cases of pectineus muscle abscess and only two cases of obturator externus muscle abscess have been reported in the literature, with only one developing as a result of genitourinary intervention such as urethrotomy.
Case presentation: Here we are presenting a case of a very unusual and serious complication in an elderly man presenting with urosepsis several months after undergoing urethrotomy.
Conclusion: Elderly men have an increased risk of sepsis, higher than that in women with UTI
Longitudinal Tissue Velocity and Deformation Imaging in Patients with Significant Stenosis of Left Anterior Descending Artery
Full text link Introduction: Myocardial longitudinal tissue velocity imaging (TVI) and strain rate imaging (SRI) indices may have a role in the prediction of significant proximal stenosis of left anterior descending (LAD) by echocardiography. Materials And Methods: Total 20 patients with proximal LAD stenosis >70% by angiography and ejection fraction ≥50%, without wall motion abnormality at resting echo (stenotic group) and 20 angiographically normal coronaries subjects with normal echocardiography (non-stenotic group) were included in the study. SRI and TVI were performed in nine segments of the LAD territory at rest. Parameters of interest included: peak systolic strain (ST, %), strain rate (SR, Second-1), and peak systolic velocity (Sm, cm/s). Results: Overal mean ST and SR showed a significant reduction in the stenotic group compared to non-stenotic group (P<0.001), while the mean Sm had no significant difference. A segment-by-segment comparison revealed a reduction of ST in 4/9 (two apical and two anteroseptal) and SR in 5/9 (three apical, septal, and anteroseptal midportion) in the stenotic group (P<0.05). Both ST and SR showed a significant reduction in three segments: anterior-apical, lateral-apical, and anteroseptal-midportion. When both ST and SR decreased in one segment, specificity and sensitivity for the diagnosis of proximal LAD stenosis was more than 80% and 55%, respectively, by Roc analysis. Conclusion: There is an overall reduction in the mean ST and SR in the segments of LAD territory with significant proximal stenosis and normal wall motion at rest and an acceptable specificity and sensitivity of SRI for the detection of stenosis in these segments
Clinicopathological Evaluation of Eyelid and Conjunctival Lesions in Patients of Farshchian Hospital in Hamadan
Full text linkIntroduction: The lesions of the eyelid and conjunctiva are benign and malignant. The ratio of benign lesions is more than the malignant, increases with age, and are easily diagnosed clinically. However, in some cases, the clinical diagnosis of malignant tumors is impossible, necessitating the final diagnosis by histopathological examination. The incidence of benign and malignant tumors differs between countries according to the genetics of the racial population or environmental factors.Materials and methods: This cross-sectional descriptive study was conducted on 424 patients with eyelid and conjunctival lesions from the Farshchian Hospital of Hamadan between 2010–2014. The final pathological report, clinical diagnosis, demographic variables including age and gender, site of lesions, and clinical appearance were extracted from medical records.Results: The lesions consisted of 159 (37.5%) eyelid and 265 (62.5%) conjunctival lesions. The predominant location was bulbar conjunctiva (35.1%), and the least was external canthus (1.7%). The most frequent lesion based on clinical diagnosis was pterygium (51.7%), and the least frequent was sebaceous glands carcinoma. The most frequent lesion based on histological diagnosis was pterygium (52.5%), and the least frequent was xanthelasma. In this study, the concordance between clinical and histological diagnosis was 90.3% that indicated the physician’s accurate diagnosis.Conclusion: According to this study, the frequency of eyelid and conjunctival lesion was similar in males and females. The prevalence of lesions in >60-year-olds is more common than that in other age groups. The benign lesions of eyelids and conjunctiva are common than malignant lesions. Despite high clinicopathological concordance, the physician should always consider the rare cases, and the pathological diagnosis must be considered for all specimens
Individual and Social Factors Affecting Nurses’ Attitudes Toward and Quality of Care Given to Patients Who Attempted Suicide
Full text linkIntroduction: Nurses are the first healthcare professionals who meet patients who attempt suicide, and their attitudes toward these patients may be important. The purpose of this study was to evaluate the effect of demographic factors on nurses’ attitudes toward patients who attempt suicide and the quality of nursing care that these patients receive.Materials and Methods: This descriptive-correlational study was performed using the convenience sampling method on 182 nurses working at selected hospitals of medical universities in Tehran, Iran. Data were collected using questionnaires that gathered information about demographics, nurses’ attitudes toward patients who attempted suicide, and the quality of nursing care provided. Data were analyzed by the Statistical Package for the Social Sciences v.20 software and by the Pearson test and t-tests.Results: Regarding social and mental aspects, we found no significant statistical relationship between age and work experience with respect to nurses’ attitudes toward and the quality of care provided to patients who attempted suicide, but women provided higher-quality nursing care than men (P=0.046). Although the relationship between education and quality of nursing care was statistically significant (P=0.007), we found no significant relationship between education and attitude.Conclusion: We found no significant relationship between age and work experience with respect to nurses’ attitudes toward, and the quality of care provided to, patients who attempted suicide, but women provided higher-quality nursing care than men. Furthermore, quality of care was higher from nurses who had a bachelor-level education, suggesting that higher-educated nurses should be recruited to care for critical patients
Risk Factors for Clostridium Difficile Infection in a Tertiary Care Hospital
Full text linkIntroduction: Clostridium difficile infections have had significant morbidity and mortality in the last decade leading to high healthcare costs. Our prospective case-control study from October 2013 to May 2015 in a tertiary care hospital in rural India aimed to evaluate the risk factors, treatment, outcome, and complications of Clostridium difficile infections in hospitalized patients.Materials and Methods: The study involved a total of 183 patients, of which 61 were cases, and 122 were controls. Data was analyzed using multivariate logistic regression.Results: Antibiotic intake in the past four weeks (p=0.003), hypoalbuminemia (p=0.001) and duration of hospital stay before the onset of diarrhea (p<0.001) were proven to have significant risk. We subdivided cases into severe and non-severe cases, and we found that complications were statistically higher in severe cases (OR= 1.685, <0.001).Conclusion: Identifying severe cases and administering timely and appropriate treatment is prudent