No abstract

A young woman with symptoms similar to common cold was referred to Vasei hospital of Sabzevar. The patient had travelled to Malaysia which was mentioned in her history. She hospitalized with symptoms of high fever, headache, and lethargy. Then, she underwent supportive therapy. In next day, the symptoms such as bone pain, myalgias, shortness of breath, abdominal pain, severe headache, eye strain and maculopapular lesions along with nausea, vomiting, and diarrhea were appeared. Laboratory findings showed high grade fever, leukopenia, and severe thrombocytopenia. Considering the findings, dengue fever was diagnosed and the patient serum sample was sent to a reference laboratory for presence of Immunoglobulin M (IgM). The aim of this study was to introduce a new case of dengue fever in Iran.

BACKGROUNDFree Flaps are viable option to cover the tissue defect. Pedicle anastomosis to vessel branches has excellent result. In some situations which there is a possibility of flap failure like shortage of vessel branches, possibility of pedicle kinking or need to vein graft, anastomosis to great vessels is justified.METHODSSix patients were allocated to study. Five cases for free jejunal flap and one case for free latissimus flap. In free jejunal flap group, pedicle anastomosis was performed as an end-side fashion to common carotid artery and internal jugular vein and in free latissimus flap, pedicle was anastomosed as an end-side fashion to superficial femoral artery and superficial femoral vein. Follow up was regular up to 20 years.RESULTSIn free jejunal flap group, there were three female and two male with age from 30 to 59 years. The sixth case was a thirteen years old male with flexion contracture of right knee who underwent free latissimus flap. Follow up was regular for 20 years. All flaps survived, and good functional result was obtained in all except one.CONCLUSIONChoosing great vessels as one side of anastomosis is safe and can be done as a primary approach due to technical demand or as a final resort when there is shortage of side branches.

This increase was mainly due to increases in the use of antibiotics for treatment of infections; the prophylactic use of antibiotics did not show a significant increase. There was an increase in the consumption of ceftriaxone, imipenem, cefalotin, metronidazole and vancomycin, a decrease in the use of erythromycin and ceftazidime and no change in the use of ciprofloxacin and clindamycin. Ceftriaxone showed the greatest increase (5.1-fold) and erythromycin the sharpest decrease (8-fold) in use.