Intestinal leishmaniasis in acquired immunodeficiency syndrome

In endemic regions, visceral leishmaniasis is one of the most common opportunistic infections in HIV positive patients. Simultaneous infection with Leishmania and HIV has been reported in some countries but this is the first report of such a case in Iran. Our patient was a 27 years old man with intermittent night fever, abdominal pain, loss of appetite, vomiting, watery diarrhea and severe weight loss for 6 months. He had low socio-economic status with an imprisonment history. The patient was quite cachectic and had low grade fever. Physical exam and upper Gl endoscopy revealed oropharyngeal candidiasis. Microscopic evaluation of duodenal biopsy material showed Leishmania amastigotes in macrophages of lamina propria. Leishman bodies were also observed in bone marrow aspiration specimen. Serologic tests were positive for Leishmania infantum. HIV antibody was also positive with a CD4[+]cell count of 807microl. The diagnosis was acquired immunodeficiency syndrome with simultaneous visceral leishmaniasis involving intestinal mucosa

[Liver steatosis and chronic hepatitis-B infection: viral and host risk factors]

Liver steatosis and chronic hepatitis B infection are the most common causes of chronic liver diseases in Iran. There have been a limited number of studies throughout the world, evaluating the association of hepatitis B infection and steatosis. We studied the association between some of viral and host factors and the presence of steatosis among patients with chronic hepatitis B infection. In this analytical cross-sectional study, 71 patients with chronic hepatitis B infection were preliminarily assessed by liver biopsy. The patients were divided into two groups based on either presence or absence of steatosis in liver tissue. These two groups were compared in terms of different host and viral factors along with their stage of fibrosis. Of 71 patients, 30 [42.3%] had significant steatosis [in >5% of hepatocytes, according to Brunt classification]. Sex and gender were not significantly different in 2 groups. The mean BMI, serum levels of FBS, cholesterol, TG, GGT, were significantly higher in steatosis group compared to those of non-steatosis one [P<0.05]. In contrast, the mean levels of AST, ALT, ALK-P were not significantly different in these groups. The frequency of HBeAg positivity and the mean level of viral load of two groups had no significant difference. There was also no significant difference in the mean stages of fibrosis between two groups. It seems that certain metabolic hosts factors such as BMI, FBS, cholesterol, TG, GGT are associated with steatosis in patients with chronic hepatitis B infection while such an association was not found with the evaluated viral factors. We suggest further investigations to evaluate the role of other factors [such as HBV genotype] in the future

[Case report: Intestinal leishmaniasis in a patient with AIDS]

In endemic regions visceral leishmaniasis is one of the most common opportunistic infections in HIV positive patients. Simultaneous infection with leishmania and HIV has been reported in some countries but there's no such report from Iran in medical literature. Patient was a 27-year-old man admitted with chief complaints of intermittent abdominal pain, anorexia and vomiting since 6 months ago. He also mentioned mild night fevers, watery diarrhea and severe weight loss during this time. He was of low socioeconomic status, was unemployed and had a history of imprisonment 4 years ago. Physical examination revealed low-grade fever [T=38.1?C] and severe cachexia [Weight=41 Kg, Height=165 cm]. Oropharyngeal candidiasis was evident in oral examination. In upper GI endoscopy, candidal esophagitis and duodenal nodularity were seen. Candidal plaques were also visible in duodenal mucosa. Microscopic evaluation of duodenal biopsy material showed partial blunting of the villi. Abundant macrophages containing intracytoplasmic microorganisms had infiltrated and expanded the lamina propria. High magnification view revealed leishmania amastigotes with nuclei and kinetoplasts. Leishman bodies were also observed in bone marrow aspiration specimen. Serologic studies [latex agglutination and Immunofluorescence antibody] were positive for Leishmania infantum. Serology for HIV antibody was also positive. CD4+ cell count was 80/microl. The diagnosis was acquired immunodeficiency syndrome with simultaneous visceral leishmaniasis involving intestinal mucosa

Correlation between prostate needle biopsy and radical prostatectomy gleason gradings of 111 cases with prostatic adenocarcinoma

There are conflicting reports in the literature about correlation of biopsy and prostatectomy Gleason scores in prostate carcinoma. The goal of this study was to determine the correlation of grading in these two types of pathologic materials. The coupled Hematoxylin and Eosin slides of 111 patients with prostate carcinoma were collected. Gleason scores were determined. Patients who had undergone any therapy except surgery were excluded from the study. Correlation between grades was calculated by determination of correlation coefficient. Accuracy of biopsy grading in prediction of final grade was also determined by measuring the sensitivity, specificity, and positive and negative predictive values. In 50 cases [45%], grade was underestimated in the biopsy. After dividing the cases into Gleason scores of 2 to 4, 5 to 6, 7, and 8 to 10, the most of undergraded cases [84.2%] were in the first group [Gleason score 2 to 4] and this rate reached 5% in the fourth group [Gleason score 8 to 10]. The correlation coefficient measured was 0.535 in grade to grade comparing and 0.514 in group to group comparison of the specimens. In low-grade tumors, grading in biopsy, in spite of high sensitivity [90.9%], had low positive predictive value [26.3%]. There is a moderate direct linear relationship between scores in biopsy and prostatectomy specimens. But there is a high probability of underestimation of real Gleason score of the radical prostatectomy specimen in low-grade tumors. Pathologists and urologists must consider the phenomenon of undergrading in reporting prostate specimens and managing patients