Parathyroid adenoma localization

Bilateral neck exploration is the gold standard for parathyroid adenoma localization in primary hyperparathyroidism. But surgeons do not have adequate experience for accurate surgical exploration and new methods are developed for surgery like unilateral exploration and minimally invasive surgery, thus, preoperative localization could reduces time and stress in surgical performance. 80 patients with documented primary hyperparathyroidism and with raised serum calcium and parathyroid hormone [PTH] were selected. The results of ultrasonographic localization for each patient were compared with findings of surgery and 99m technetium sestamibi scintigraphy. Also variables such as preoperative serum calcium, PTH level and adenoma weight were compared between patients who had localized and nonlocalized adenoma with ultrasonography or Sestamibi scan. The data was compared with student's t-test. In a prospective diagnostic tests' accuracy, 80 patients with primary hyperparathyroidism were enrolled. Ultrasonography images detected enlarged parathyroid glands in 61 of 80 patients [76.3%] with sensitivity of 83.5% and positive predictive value [PPV] of 89.7%. Sestamibi scintigraphy detected adenoma in 63 patients [78.8%] with sensitivity of 85% and PPV of 91.3%. There was no significant deference between ultrasonography and scintigraphy in localization of adenomas. Both ultrasonography and scintigraphy used for determining localization, and they located 73 adenomas [91.3%] with sensitivity of 97.3% and PPV of 93.5%. Ultrasonography as an accurate method for localization of enlarged parathyroid glands in primary hyperparathyroidism, is comparable in overall utility with sestamibi scintigraphy. This study suggests a strategy for initial testing with one method, followed by the alternate imaging test if the first test happen to be negative

Seroprevalence of toxoplasmosis in HIV+/AIDS patients in Iran

Toxoplasma gondii has arisen as an important opportunistic agent especially in the central nervous system and in advanced HIV disease can cause significant morbidity and mortality. This study was carried out to determine the seroprevalence of toxoplasmosis among HIV-positive patients in Iran. Blood samples were collected from 201 HIV-positive patients and anti-toxoplasma antibodies were detected by using conventional ELISA. An antibody titer of >3 IU/ml was considered positive. The majority of studied patients were male [male to female ratio: 5 to 1] with the mean age of 36 +/- 1 yrs. The seroprevalence of toxoplasmosis in HIV-positive patients was 49.75%. The mean CD4 count in HIV patients with positive toxoplasma serology was 332.5 +/- 22.4 cells/micro l. Only 1% of the patients had IgM anti-toxoplasma antibodies and 10% of the patients had clinical toxoplasma encephalitis. The mean CD4 count in this group was 66.4 +/- 15.5 cells/micro l and there was a significant association between CD4 count and rate of toxoplasma encephalitis [P<0.001]. Previous reports suggested that toxoplasma encephalitis could be prevented by appropriate chemoprophylaxis. In view of the relatively high prevalence of toxoplasma infection found among the HIV-infected patients in our study, we suggest that routine screening for toxoplasma should be undertaken for all HIV-infected patients in Iran

Hepatitis-C and hepatitis-B co-infections in patients with human immunodeficiency virus in Tehran, Iran

We carried out a study to determine the seroprevalence of HBV and HCV infections in HIV positive patients at a main referral center for HIV/AIDS in Iran. Serum samples from 201 HIV positive patients referring to a referral center for HIV/AIDS were analyzed for the presence of some hepatitis B [HBsAg, anti-HBc, anti-HBs] and Hepatitis C [anti-HCV] markers, during 2004- 2005. HBsAg was positive in 27 patients [13.4%], anti-HBc was positive in 60 patients [29.8%] and anti-HBs in 23 patients [11.4%]. Anti-HCV Ab was positive in 135 of 201 [67.2%]. HBV and HCV coinfection was observed in 73 of 201 [36.3%]. The maximum prevalence of HBV-HIV and HCV-HIV coinfections were seen in intravenous drug users; 61.2% and 85.1%, respectively [P<0.0001]. The minimum prevalence of HBV-HIV and HCV-HIV were seen in HIV patients wife [HIV+ patients who were infected by monogamous sexual contact with their HIV positive husband] both of them were 8% [P<0.0001]. This study showed that HBV-HIV and HCV-HIV coinfections are significant in patients with HIV/AIDS in Iran. A greater relevance was observed in the association between HCV and HIV. This study suggests that it is necessary to investigate risk factors and risk groups for these infections in Iran

Cytomegalovirus co-infection in patients with human immunodeficiency virus in Iran

Serum samples from 201 HIV positive patients were collected to determine the seroprevalence of CMV infection in Iranian HIV infected patients during March 2004 until March 2005 using conventional ELISA kits. An antibody level of>1.1 Iu/ml was considered positive. The seroprevalence of CMV infection was 94%.The maximum prevalence of CMV antibody was seen in patients with unsafe sex and IDUs. Prevalence of CMV was much higher in patients with low socioeconomic status and low level of education. 83% of patients with CD4<100 were CMV seropositive. Our study showed that a significantly high prevalence of CMV in HIV positive patients in Iran. By increasing the level of education and socioeconomic status the prevalence of CMV infection decreased

Effect of incisional site infiltration of Bupivacaine on postoperative pain and meperidine consumption after midline laparotomy

The purpose of the current study was to determine whether infiltration of bupivacaine in the incision site of midline laparotomy reduces postoperative pain and opioid consumption. Fifty-six, 30-60 year-old patients who were undergoing midline laparotomy were enrolled in the present study. The patients were randomly assigned into two groups of control [group C, n = 28] or bupivacaine [group B, n= 28]. Just before suturing, the incision sites were infiltrated by 20 ml epineprinated bupivacaine 0.25% [group B] or 20 ml normal saline as placebo [group C]. The patients were asked to score their pain at 6, 24, and 48 hours after surgery. Demographic characteristics of the patients were similar in the two groups. There was no significant difference in the mean of visual analogue scale pain scores measured over time between the two groups. There was a significant difference in post operative meperidine consumption between the two groups, and in the bupivacaine group, meperidine request was less [90.53 +/- 13.36 mg in bupivacaine group v127.5 +/- 23.14 mg in the control group, P < 0.05]. After midline laparotomy, incisional site infiltration with 20 ml epineprinated bupivacaine 0.25% causes a significant decrease in postoperative meperidine consumption

Sensitivity and specificity of self-reported symptoms for exercise-induced bronchospasm diagnosis in children

Exercise-induced bronchospasm [EIB] is a common condition in elite athletes. The purpose of this study was to evaluate the diagnostic value of self-reported EIB symptoms in children. In a cross sectional study in 2005, all soccer player boys of 3 football schools of Shahr Rey a town in the south of Tehran, enrolled in this study. All subjects were asked for the presence of four cardinal symptoms of EIB [cough, wheeze, shortness of breath, chest pain/discomfort] during and after exercise. Self reported symptom-based EIB was defined as having at least two out of four symptoms. Findings were compared to spirometric criteria as a gold standard test. A total of 371 boys were enrolled in this study. The mean age of children was 11.67 +/- 1.53 years [range 7-16 years]. According to spirometric findings, 74 [19.9%] subjects had EIB. The sensitivity and specificity of self-reported symptoms for EIB diagnosis were 13.0% and 89.9%, respectively. Self-reported symptoms of EIB in children can be useful for epidemiological study. Our results in Iran are comparable with studies in other countries and point to a relatively high prevalence of EIB among athlete children

prevalence of exercise-induced bronchospasm in soccer player children, ages 7 to 16 years

This study represents an attempt to determine the prevalence of exercise-induced bronchospasm among soccer player children. A total of 234 soccer player boys of all soccer schools from Shahr-Rey enrolled in this study. They did not have any history of a recent or chronic respiratory tract disease, a history of allergic diseases, and history of bronchodilator drugs consumption during the 24 hours prior to the study. Pulmonary function test [PFT] was performed for each participant before exercise and 6 and 15 minutes after playing soccer. The diagnosis of EIB was by a decrease in forced expiratory volume in 1 second [FEV1] by at least 10% and in peak expiratory flow rate [PEFR] by at least 15% with exercise challenge. If there was reduction in one parameter alone, the participants were considered as prone to EIB. Considering both FEV1 and PEFR the prevalence of EIB was 2.1% and 18.4% were prone to EIB. If FEV1 or PEFR tests were used as criteria for diagnosis of airway obstruction, the prevalence of EIB would be 6% and 15.8%, respectively. There was no significant difference between the post of players, family history of allergic disease and EIB in soccer players. This study suggests that at least 2.1% of soccer players will develop bronchospasm even if they do not have any history of asthma and allergy