[Efficacy of stool antigen test for the non-invasive diagnosis of helicobacter pylori infection in dyspeptic patients referred to GI clinic of Kashan Shahid Beheshti hospital during 2007-8]

Dyspepsia is one of the most common ailments today and Helicobacter pylori infection is known as one of the common causes of dyspepsia in adults and children. Histopathologic diagnosis of Helicobacter pylori is a standard method and biopsy samples can be obtained by invasive endoscopy method. The current study was designed to evaluate the diagnostic value of stool antigen test of Helicobacter pylori as a non-invasive method. In this study all dyspeptic patients referred to GI clinic of Kashan Shahid Beheshti Hospital from 2007 to 2008 were involved in this study. In upper gastrointestinal endoscopy, mucosal biopsy was taken from antrum and corpus; simultaneous examination of the stool antigen sample for diagnosing of Helicobacter pylori was evaluated using ELISA method [positive titer>1/1]. Data were collected and analyzed for sensitivity, specificity, positive predictive value and negative predictive value. Among the 100 dyspeptic patients 50 were men and the remaining 50 women with a mean age of 43.3 +/- 17.13. The sensitivity, specificity, positive predictive value and negative predictive value in stool antigen test were%83.3,%79.4, 88.7% and 71.7%, respectively. There was a direct correlation between the severity of Helicobacter pylori infection and stool antigen titer in biopsy samples. The stool antigen test as a noninvasive method of diagnosing Helicobacter pylori can be regarded as an affordable alternative to the invasive biopsy procedure

[Evaluating the efficacy of anti-cyclic citrullinated peptide antibody in the diagnosis of rheumatoid arthritis disease]

Background: Rheumatoid arthritis is one of the most common autoimmune diseases. Early diagnosis can prevent side effects and disability. Anti-cyclic citrullinated peptide antibody is a specific marker to diagnose rheumatoid arthritis. This study was carried out to evaluate the efficacy of anti-cyclic citrullinated peptide in comparison with rheumatoid factor in rheumatoid arthritis patients referred to Behshti Hospital of Kashan city during 2006-7

Materials and Methods: This diagnostic value study was done on 98 randomly selected rheumatoid arthritis patients and 75 patients with other rheumatic diseases. In this study rheumatoid factor titer>35 IU/ml and anti-cyclic citrullinated peptide>6.25 IU/ml were considered positive

Results: Anti-cyclic citrullinated peptide compared to rheumatoid factor had a higher sensitivity [73.5% vs. 69.4%], specificity [88% vs. 84%], positive predictive value [88.9% vs. 85%], and negative predictive value [71.7% vs. 67.7%] for rheumatoid arthritis. The use of rheumatoid factor and anti-cyclic citrullinated peptide test together increased the specificity and positive predictive value for diagnosis of rheumatoid arthritis to 93.3% and 92.4%, respectively. The mean anti-cyclic citrullinated peptide showed a significant difference in Rheumatoid arthritis [46.8 IU/ml] in comparison to non rheumatoid arthritis patients [5.3 IU/ml]

Conclusion: Anti-cyclic citrullinated peptide had a better diagnostic value when compared to rheumatoid factor for detection of rheumatoid arthritis. Also combined use of rheumatoid factor and anti-cyclic citrullinated peptide had a higher specificity and positive predictive value than each alone for the diagnosis of rheumatoid arthritis

[Cutaneous tuberculosis presented by chest wall fistula formation]

Tuberculosis is one of the world's most debilitating diseases and it is at the top of six most prevalent and dangerous infectious diseases recognized by World Health Organization. Although one out of every three people in the world is affected by Mycobacterium tuberculosis, cutaneous infection is a relatively uncommon event. Here, we report a rare form of cutaneous tuberculosis presented by multiple fistulas over the anterior chest wall. This is a 50 year old insulin-dependent diabetic man from Afghanistan who was presented with a history of multiple skin lesions over his anterior chest wall for 3 months duration. At first, there was a single non-painful, small popular lesion, which became fistulized and developed purulent discharge, later. The patient was suspected as a case of cutaneous tuberculosis according to his nationality and prolonged history of unresponsiveness to outpatient antimicrobial treatment. This diagnosis approved based on skin biopsy result as it revealed multiple granulomas consisted of giant Langhans cells and the detection of numerous acid fast bacilli in the Ziehl-Neelsen staining of the skin secretions. Six weeks after treatment with anti-tuberculosis drugs, the signs of improvement were appeared and 6 months later there was no active fistula any more. Cutaneous tuberculosis may present itself in uncommon forms such as fistula. It might be seen anywhere including chest wall. Therefore, this impression should be considered in patients with prolonged skin lesions and featured by fistula formation

[Diagnostic value of pleural adenosine deaminase activity in discrimination of exudative from transudative effusion]

Background: the differentiation of pleural effusions as exudates or transudates is the first step in the diagnosis of pleural effusions. The aim of this study was to evaluate the usefulness of pleural adenosine deaminase [PADA], for separating transudative pleural effusion from exudative pleural effusion

Materials and Methods: using light's criteria, after careful evaluation of all relevant clinical and biochemical parameters of pleural fluid and serum, classically effusions were classified to transudative or exudative. The means and standard deviations of PADA, and pleural/serum ADA [P/S ADA] ratio were calculated for transudative and exudative effusions .The best cut-off values for each test were identified by using the receiver operating characteristic [ROC] curve

Results: we compared PADA levels between transudative and exudative patients with pleural effusion. According to the criteria used, 32 patients were included in the transudate group and 73 patients in the exudate group. Pleural fluid ADA levels were significantly lower in the transudate group than in exudate one [16.21 +/- 6.10 U/lit vs. 22.24 +/- 7.50 U/lit; P<0.001]. Also the mean pleural fluid/serum ADA ratio were [P<0.0001] lower in transudates as compared to exudates [0.76 +/- 0.32 vs. 0.91 +/- 0.26; P=0.021]. Using a cut-off point of 14.5 IU/L, the sensitivity and specificity of pleural ADA in the diagnosis of exudates was computed to be 84.7% and 48.3% respectively. At a cut-off point 0.75, pleural fluid/serum ADA ratio was found to have sensitivity and specificity of 73.2% and 65.5% , respectively

Conclusion: measuring PADA is suggested as a useful biochemical marker in differentiating between pleural exudates and transudates

Pulmonary alveolar microlithiasis

A 40-year-old male patient was referred with a history of exertional shortness of breath since a few years ago. Spirometric findings were consistent with a restrictive ventilatory defect. Plain chest radiographs showed sand-like opacities throughout both lungs predominantly in the lower zones. Computerized tomographic scan revealed diffuse bilateral calcified fine nodular pattern. The diagnosis of pulmonary alveolar microlithiasis was confirmed by transbronchial biopsy