Reza Akhavan

Antibiotic Resistance Properties of Pseudomonas aeruginosa Isolated From Cases of Superficial Infections at the Emergency Unit.

Background Pseudomonas aeruginosa, a ubiquitous opportunistic pathogen, is one of the main causative agents of human superficial infections. Infections due to these bacteria are difficult to heal and cause serious economic issues. Objectives The present study was carried out to investigate the antibiotic resistance pattern of P. aeruginosa isolated from cases of superficial infections referred to the emergency health care units of Iranian Hospitals. Materials and Methods Three hundred swab samples were collected from patients with superficial infections. Samples were cultured and those that were P. aeruginosa positive were analyzed by the disk diffusion method. Results One hundred and seventy-two out of 300 swab samples (57.3%) were positive for P. aeruginosa. The results of the culture technique were also confirmed using the polymerase chain reaction (PCR). Females had a higher prevalence of P. aeruginosa than males, patients older than 70 years were the most infected age group and finally burn infections had the highest prevalence of bacteria. P. aeruginosa strains had the highest levels of resistance against ampicillin (93%), gentamycin (89.5%), ciprofloxacin (82.5%) and amikacin (77.3%). The most effective drugs were meropenem (2.3%, imipenem (2.9%), polymyxin B (21.5%) and cotrimoxazole (31.9%). Conclusions It is logical to primarily prescribe meropenem, imipenem, polymyxin B and cotrimoxazole in the cases of superficial infections caused by P. aeruginosa. Medical practitioners should be aware of the presence of such levels of antibiotic resistance in cases of superficial infections in Iran.

Association between clinical and sonographic synovitis in patients with painful knee osteoarthritis

To evaluate the association between ultrasonographic findings of inflammation (effusion, synovitis) and clinical findings in patients with primary painful knee osteoarthritis.

The Diagnostic Value of MRI in Brucella Spondylitis With Comparison to Clinical and Laboratory Findings

Background: Brucellosis is an endemic zoonotic disease, especially in the Middle East and Mediterranean regions and can involve many organs and tissue. Osteoarticular involvement is the most common complication. Spondylitis is its most prevalent clinical form in adults, and there may be difficult in diagnosis and treatment. In present study, we aimed to assess these diagnostic value of MRI, in patients with spondylitis due to brucella, comparing with clinical and laboratory findings. Method: Patients with low back pain who were admitted to Sheikhol-raees MRI center were included in this study. None of these patients had any documented infectious disease. Diagnosis of brucellosis was made, based on MRI findings, which would be approved by serology. After confirmation with serology, the group with positive serology were compared with the negative group, in sex, age, MRI findings level of vertebral involvements, signal intensity in T1 weighted and T2 weighted. Results: Among 53 patients with diagnosis of brucella spondylitis, 33 underwent serology study, 20 were positive and 13 were negative and the others consider out of study. From these 20, 3 had tuberculosis spondylitis, whose mean age was 56 and the 67% of them were male. Mean age in the positive brucella spondylitis were 46 and 67% of them were male. In negative group mean age was 55, and of whom 57% were male. There was no statistically significant difference in MRI findings such as changes in signal intensity, disk space narrowing, Intracanalicular mass, Abscess formation. Level of invlovment in vertebrae. Conclusion: The results of this study shows that although MRI is Modality of choice in diagnosis of spondylitis, it is not enough specific to diagnosis the reasons of spondylitis.

Devastating Renal Injury After a Low Energy Trauma: Was the Force Sufficient?

Introduction: Renal traumas are quite commonly encountered in emergency departments. Low-energy traumas are often considered non-significant, but the presence of a pre-existing renal lesion predisposes the kidneys to more severe damage in the setting of even minor traumas, which may be accompanied by devastating results, should they remain unattended. Case Presentation: Here we report an incidental diagnosis of bilateral ureteropelvic junction obstruction in a patient who presented with unexpected shattered kidney following a low-energy flank injury. Conclusions: Patients with a pre-existing renal lesion are vulnerable to severe traumatic renal injuries, even after minor trauma. The severity of renal injuries may be much more than expected, making the clinical and imaging findings complex and confusing in these patients.

Hemorrhagic Colloid Cyst Presenting with Acute Hydrocephaly

Colloid cysts are benign slow-growing cystic lesions located on the roof of the third ventricle that usually present with symptoms related to gradual rise of intracranial pressure. They mostly remain asymptomatic and sometimes grow progressively and cause diverse symptoms associated with increased intracranial pressure such as headache, diplopia, and sixth cranial nerve palsy. Here we report a 47-year-old female who presented to the emergency department with acute severe headache and nausea/vomiting. On MRI examination acute hydrocephaly due to hemorrhagic colloid cyst was detected. Acute hemorrhage in colloid cysts is extremely rare and may present with symptoms of acute increase in the intracranial pressure. Intracystic hemorrhage is very rarely reported as a complication of colloid cyst presenting with paroxysmal symptoms of acute hydrocephaly.

Gas Bubbles in the Bone: A Case Report.

Intraosseous pneumatocysts are benign gas-filled cavities within bones which are most commonly found in ilium, sacrum and vertebrae. The lesions are asymptomatic and found incidentally while evaluating for other injuries. Here, we present an intraosseous pneumatocyst of ilium in a 23-year-old male patient. Although once thought to be rare, intraossseous pneumatocyst are now believed to be more common. Thus, familiarity with their appearance is essential to avoid unnecessary workup. Intraosseous pneumatocysts are differentiated from more clinically significant differential diagnoses like osteonecrosis and osteomyelitis by their characteristic appearance of intraosseous air collections with sclerotic rim.

A Bed-Ridden Man with Sudden-Onset Dyspnea

On the initial examination, the patient had tachypnea and tachycardia, without fever. Oxygen saturation on room air was 80%. Chest auscultation revealed crackles in the right lower chest. Findings of the laboratory examination revealed increased C-reactive protein and D-dimer levels. Echocardiogram changes were nonspecific.With the clinical suspicion of acute pulmonary thromboembolism, the patient underwent pulmonary computed tomography angiography.

A man with disabling low back pain: Echinococcus of the sacrum

Bone involvement in hydatid disease is rare, and when it does occur, the most common sites of involvement are the spine and pelvis. A case of bone hydatid disease involving the sacrum is reported here.