MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2011 | Volume:54 | Issue:1|Papers Count:12

Introduction: Differential diagnosis between Tuberculosis pleurisy and Non Tuberculoses pleural effusion can be sometimes difficult and needs invasive diagnostic methods. In recent years, several biological markers have been found to be diagnostic markers of Tuberculosis pleurisy. The aim of this study was assessment of the value of Gamma-Interferon in the diagnosis of TB pleurisy.Materials and Methods: We studied 70 patients with pleural effusion who had been admitted to Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Interferon gama level was measured by "ELISA" method. The diagnosis of tuberculosis was based on microbiologic study of pleural fluid plus pleural biopsy.Result: Altogether Twenty patients had tuberculosis pleurisy (44.44%), 21 patients had malignant pleural effusion (46.67%) and 4 patients had pleural effusion with various non TB non malignant etiologies (8.9%). The sensitivity, specificity of Gamma-Interferon in TB pleurisy were 60% and 96% respectively.Conclusion: INFg is a valuable indicative marker for diagnosis of tuberculosis pleurisies’ but we should consider situations with high level of INFγ without any evidence of TB and also Tuberculsis Pleurisy patients with INFg level lower than diagnostic threshold.

Introduction: The aim of this study was to assess and compare the diagnostic accuracy of Helicobacter pylori stool antigen (HpSA) test with three other invasive and non-invasive diagnostic methods.Materials and Methods: A total of Fifty-two dyspeptic patients were included. None of the patients had previous eradication therapy for Helicobacter pylori. Endoscopic biopsy samples were obtained for histology examination and Rapid Urease Test (RUT). Urea Breath Test (UBT) and HpSA were also performed. Patients were considered Helicobacter pylori positive when 2 of 3 tests (histology examination, RUT and UBT) were positive (gold standard). Diagnostic accuracy of HpSA was assessed performing a Receiver Operating Curve (ROC) analysis.Results: Twenty-three Were men and 29Were women, with a mean age of 42.3 years of the Palients. The prevalence of Helicobacter pylori infection was 67.3%. ROC curve analysis was showed a significant area under curve of 94.6% (p=0.0001). Cut-off value was estimated to be 0.1. The sensitivity, specificity, positive and negative predictive values of HpSA was 91.4%, 94.1%, 97% and 84%, respectively. HpSA level significantly increased with increasing in bacterial load.Conclusion: HpSA was proved to be a highly accurate, simple and non-invasive test for the diagnosis of Helicobacter pylori infection before treatment in dyspeptic patients.

Introduction: Objectives: Preeclampsia, clinically recognized by gestational hypertension with proteinuria, occurs after 20 weeks' gestation is a leading cause of maternal and perinatal morbidity and mortality. Early diagnosis to prevent maternal and fetal complications is important. The gold standard for proteinuria, is a 24-hour urine sample for total protein. The purpose of this study was to compare the urine protein in the 8 –hour Sample with the 24-hour Sample Urine Profein to diagnose of preeclampsia.Materials and Methods: The study population included 76 in patients with hypertensive disorders of pregnancyduring 2009 and 2010. Patient's urine was collected over 24 hours with the first 8 hours, next 16 hours, in separate containers. The urine volume and total protein and creatinine levels were measured in the 8 and 24 hour samples. The results of 8 and 24-hour Sample were compared by useing of SPSS software Win PePi 1.45. The correlation between 8 and 24-hour tests was evaluated using Pearson and Spearman correlation coefficients. Of the 76 patients 18 cases had no proteinuria, 53 had mild proteinuria and 5 had severe pro-teinuria.Results: protein values for the first 8 hour sample have high correlation with the entire 24 hour sample for patients with mild (p<0.001,r=0.87),severe disease (p<0. 001 ,r=0.9). In cases with no proteinurea moderate correlation was found (P<0.001, r=0.59).Conclusion: The 8-hour sample correlates with the 24-hour sample for patients with no proteinuria (p<0.001), mild proteinuria (p<0.001) and severe proteinuria (p<0.001).

Introduction: Coronary artery disease is the first etiology of mortality in Western countries and it was predicted, that up to the year 2010 it would be the main cause of human morbidity. With Respect to the increasing frequency of coronary artery disease, proper diagnosis, treatment and prevention of complications have a great importance. Many patients with chest pain could not perform diagnostic ETT, so in this group dobutamin stress echocardiography was a suitable low cost, safe, accessible & exercise independent modality of stress. Regarding the recent usage of dobutamine stress echocardiography in our country & especially in khorasan province,the aim of this descriptive study was to present 500 patients whom referred to Ghaem hospital echocardiography laboratory for ischemic diagnosis or viability assessment or both. Materials and Methods: This study consisted of 500 patients, 273 males (54.6%) ,and 227 Females (45.4%0), 20-80 years old and also were symptomatic for ischemia. These cases were referred to Ghaem echo lab for ischemia/ viability detection between 1385-1386.Results: Our study Patients had: systemic hypertension (46.8%), hypercholesterolemia (39.8%), diabetes (29.5%), smoking (12.6%), previous MI (11.1%) positive family history 8% CRF (8%) and obesity (5%). Among patients 345 (69%)were referred for ischemia detection, 132 (26.4%) referred for viability assessment , 23 (4.6%) for both of them, the left ventricular systolic function was normal in 168 (26.8%), mildly abnormal in 25.3%, moderate dysfunction in 12.8%, severe dysfunction in 128 patients with complication consideration, 402 patients (80.5%) had no complication and in the other patients (19.5%) test complication were occurred as arhythmia, PVC, palpitation, vomiting, nausea, rigor and the other mild complications.Conclusion: Dobutamine stress echocardiography is an exercise independent stress modality with good safety and low level of complications.

Introduction: It is estimated that by the year 2050 about 20% of the world population are 65 years or older. Infections are cause of 30% of mortality in this age group. Impairment of Cellular and humoural immunity, reduced physiological reflex, increased prevalence of chronic diseases and so Forth are possible for increased frequency of infection in the elderly.Materials and Methods: This descriptive study was performed on 272 elderly patients, admitted to the Infectious Diseases ward; Imam Reza hospital of Mashad, the most important clinical and paraclinical findings and final diagnosis were collected by SPSS and analyzed with T-Test, Chi-Square and Fisher’s Exact test.Results: Approximately 31% of patients admitted during one year in infectious Diseases ward were old people of these 53% were female and 47% were male. The most common complaints of patients were respiratory problems (45%) and the most common diagnosis was pneumonia (%43).AL together 39% of patients changed in mental status and 51% suffered a chronic medical disease. Mortality rate in patients was 19/5%.Conclusion: Seems Infection to be one of the common causes of hospitalization in the elderly and despite amenity of modern methods and new antibiotics; it accompanies a high mortality rate in this age group. Attention to the danger signs and risk factors such as age ,decreased level of consciousness, immune deficiency and early treatment may reduce mortality in these patients.

Introduction: Many different tests have been introduced for screening of gestational diabetes mellitus (GDM).The Objectives of this study were comparison of diagnostic value of fasting plasma glucose (FPG) with 100 gram oral glucose tolerance test (OGTT) and determining the suitable cut-off point of plasma glucose with best sensitivity and specificity for diagnosis of gestational diabetes mellitus (GDM).Materials and Methods: This study was a clinical trial and Carried out on 242 women in Karaj-Iran. After doing 50 gram glucose challenge test (GCT), if 1-hour plasma glucose was £130 mg/dl, the 3 hours 100 gram OGTT was performed. The diagnostic values of FPG and 1, 2 and 3 hours plasma glucose were compared by receiver operating characteristic curve (ROC).Results: Overall 50 gram GCT was positive in 41/3%. Then 100 gram OGTT for these was performed, 36% were identified as GDM. With using below surface of ROC curve for FPG (o/75), 1-hour (0/87), 2-hour (0/95) and 3-hour (0/75) plasma glucose determined that FPG with cut-off point £91 mg/dl had 63.89% sensitivity rate and 76/56% specificity rate for diagnosis of GDM. However, 2-hour plasma glucose with cut-off point £153 mg/dl had highest level of sensitivity rate (91/67%) and specificity rate (89/06%).Conclusion: Two-hour glucose with cut-off point £153 mg/dl had the best sensitivity and specificity rate in diagnosis of GDM. Therefore, 100 gram OGTT recommended for screening of GDM.

Introduction: Asthma, allergic rhinitis and urticaria are common diseases in the world. The aim of this study was to investigate the aeroallergen by skin prick test in patients, in Mazandaran province, Sari (Iran). Materials and Methods: This was a prospective study of skin prick test of aeroallergens in patients with asthma, allergic rhinitis or both and urticaria based on clinical and Para clinical criteria. Eight hundered and nine cases were referred to Tooba and Boo-Ali allergic centers in Mazandaran University of Medical Sciences between December 2006 and July 2010. The aeroallergens were included; House dust mites (DF, DP), Coach Roach, Feather, Aspergillus, Alternaria, Pigweed, Nettle, Oak, Maple and others. Negative (normal saline) and positive controls (histamine) were applied for all patients.Results: Atotal of Three hundred and fifty out of 809 cases were males (43%) and 459 cases were Females (57%). The age range was between 5 and 50 years old, 42.5 percent (n= 340) of patients had ages between 10 and 20 years old. In asthma, allergic rhinitis or both and urticaria, the prick test DF 32%, DP 33%, Cockroach 22% and feather 9 were positive. Other allergens were positive between 0 and 10 percent, except candida which was 28% positive. Total IgE levels and Eosinophil count was increased in 54 and 35 percent of cases, respectively.Conclusion: Due to warm and humid weather in north of Iran (Sari), house dust mites are more common.

Introduction: Coronary artery bypass graft is one of the most common surgeries in hospitals. Almost 50% of patients have complications. One of these complications is hearing loss.Materials and Methods: Coronary artery bypasses grafting patients having inclusion criteria participated. One day before surgery, One day after surgery and if patients had hearing loss, the next week otoacoustic emission test was done. Patients were divided in to two groups: on pump and off pump bypass surgeries.Results: Hearing loss occurred in 12%. Hearing loss in on-pump patients was 14.3% and in off-pump was 6/7% (p=0.09). The relation of preoperative OAE test and final OAE was tested and it was significant (p<0.005). In male patients, hearing loss in on-pump operation was 18/6% (p=0.002) and in females in on-pump operation was 7/4% and in off-pump operation was 18.2 %( p=0.1). Hearing loss occurred in 4/2% in 1500, 2000 HZ; 12/5% in 2500, 3000 HZ and 83/3% in 3500, 4000 HZ.Conclusion: It after coronary artery bypass graft is rather Frequents (12%) and is more common in on-pump surgery, and occurs in high frequency. hearing loss is more common in male patients.

Introduction: Glycogen storage diseases (GSDs) comprise several rare inherited diseases caused by abnormalities of enzymes that regulate the synthesis of Glycogen. Case report: A- 26 years old man admitted to the hospital because of pain and swelling in his ankles. Also, he had delay of puberty. In diagnostic evaluation, the patient had hyperuricemia, hyperlipidemia and adenomatous nodules in the liver. Liver biopsy revealed Glycogen storage disease type 1.Conclusion: Gouty arthritis in glycogen storage disease is not uncommon; however, glycogen storage disease as a reason of gouty arthritis is rare. Because of growth failure, delayed puberty and laboratory results we strongly suspected to an underlying disease as a cause of hyperuricemia and gouty arthritis leading to glycogen storage disease diagnosis.