A computer-aided diagnostic system for kidney disease

BACKGROUND: Disease diagnosis is complicated since patients may demonstrate similar symptoms but physician may diagnose different diseases. There are a few number of investigations aimed to create a fuzzy expert system, as a computer aided system for disease diagnosis. METHODS: In this research, a cross-sectional descriptive study conducted in a kidney clinic in Tehran, Iran in 2012. Medical diagnosis fuzzy rules applied, and a set of symptoms related to the set of considered diseases defined. The input case to be diagnosed defined by assigning a fuzzy value to each symptom and then three physicians asked about each suspected diseases. Then comments of those three physicians summarized for each disease. The fuzzy inference applied to obtain a decision fuzzy set for each disease, and crisp decision values attained to determine the certainty of existence for each disease. RESULTS: Results indicated that, in the diagnosis of seven cases of kidney disease by examining 21 indicators using fuzzy expert system, kidney stone disease with 63% certainty was the most probable, renal tubular was at the lowest level with 15%, and other kidney diseases were at the other levels. The most remarkable finding of this study was that results of kidney disease diagnosis (e.g., kidney stone) via fuzzy expert system were fully compatible with those of kidney physicians. CONCLUSION: The proposed fuzzy expert system is a valid, reliable, and flexible instrument to diagnose several typical input cases. The developed system decreases the effort of initial physical checking and manual feeding of input symptoms.

Time trend analysis and demographic features of inflammatory bowel disease in Tehran

This retrospective study is aimed to review demographic and clinical characteristics of IBD to elucidate the probable factors associating with IBD development in Taleghani Hospital in Iran since 2001 during a 12-year-period. Ulcerative colitis [UC] and Crohn's disease [CD] are two major idiopathic entities of inflammatory bowel disease [IBD]. Previous studies have reported an increased incidence of IBD in Middle East countries. In the present study 1914 patients with UC, 318 patients with CD and 25 with indeterminate colitis [IC] were included. Demographic information, clinical features, extraintestinal manifestations, complications and extension of disease were collected and interpreted for all participants. According to the time of registration, patients were divided into seven groups. Statistical analysis was performed using the chi-square test. In seven groups of IBD patients, disease registry was estimated for UC, CD, and total IBD during a 12-year-period. From 2001 to 2005, a relative increased registry was observed among UC patients. However, in the years 2006 and 2007 a significant reduction in the number of patients was reported. Then an increasing trend was observed in UC patients. UC presented mostly with diarrhea, hematochezia and bloody diarrhea, while most of CD patients complained of abdominal pain. Evaluation of data related to registered IBD patients in Iran shows that probable incidence and prevalence of IBD [UC and CD] is increasing compared to previous decades

Significance of response to hepatitis b recombinant vaccine in subjects with isolated antibody to hepatitis b core antigen

It is important to differentiate whether isolated anti-HBc is due to false positive results or the prior exposure to hepatitis B virus, because individuals with false-positive anti-HBc can benefit from vaccination and their blood can be safely transfused. To distinguish between these two conditions, we evaluated the serologic response to hepatitis B vaccine. Ninety subjects with isolated anti-HBc [cases] and 100 subjects with totally negative hepatitis B serologic markers [controls]] were recruited to receive three doses of hepatitis-B [HB] vaccine. Thirty days after the first dose of the vaccine, anti-HBs titers were checked and individuals with anti-HBs titer >50 mlU/mL did not receive additional doses of the vaccine. However, others completed the vaccination course, and another blood sample was collected 30 days after the third dose to measure anti-HBs level. Nineteen [21.1%] cases and three [3%] controls had no sero-conversion [anti-HBs titers <10 mlU/mL] 30 days after the third dose [p<0.000l]. Primary response, defined as the development of anti-HBs antibody titers >10 mlU/mL 30 days after the third dose, was observed in 43 [47.8%] cases and 92 [92%] controls [p<0.000l]. Also, 31.1% of cases developed anti-HBs titers > 50 mlU/mL 30 days after the first dose of vaccine, but the rate was significantly lower [5%] in the control group [P<0.0001]. Furthermore, half of the individuals with positive isolated anti-HBc developed protective levels of anti-HBs after three doses of HB vaccination. More than 75% of individuals with positive isolated anti-HBc can benefit from vaccination and can be included in donor pool. Also, one fifth seemed to have occult HBV infection. So HB vaccination may be used as a diagnostic tool for clarifying the situation of the subjects with isolated anti-HBc

Target antigens for perinuclear antineutrophil cytoplasmic antibodies in Iranian patients with ulcerative colitis

Patients with ulcerative colitis [UC] carry autoantibodies such as perinuclear antineutrophil cytoplasmic antibodies [p-ANCA]. The aim of the present study was to evaluate the target antigens for p-ANCA in Iranian patients with UC. p-ANCA target antigens including elastase, lactoferrin, cathepsin G, myeloproxidase, lysozyme, and bactericidal permeability increasing protein [BPI] were determined in 113 patients with UC using enzyme-linked immunosorbent assay [ELISA]. 59.2% of the patients were positive for at least one antigen and p-ANCA directed against lactoferrin, elastase, lysozyme, cathepsin G, Bactericidal permeability increasing protein, and myeloproxidase in 31.5%, 25.9%, 8.3%, 7.4%, 5.6%, and 0% of the patients, respectively. The highest prevalence of p-ANCA was observed against lactoferrin and elastase. Also, myeloproxidase was not an antigen for p-ANCA among our patients

Association of tumor necrosis factor alpha gene polymorphisms with inflammatory bowel disease in Iran

Inflammatory bowel disease [IBD] is a chronic disease of unknown etiology, in which genetic factors, seem to play an important role in the disease predisposition and course. Assessment of tumor necrosis factor [TNF- alpha] gene polymorphisms in many populations showed a possible association with IBD. Considering the genetic variety in different ethnic groups, the aim of the present study was to investigate the association of five important single nucleotide polymorphisms [SNPs] in the promoter region of [TNF- alpha] gene with IBD in Iran. In this case-control study, 156 Ulcerative colitis [UC] patients, 50 Crohn's disease [CD] patients and 200 sex and age matched healthy controls of Iranian origin were enrolled. The study was performed during a two year period [2008-2010] at Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. DNA samples were evaluated for [TNF- alpha] gene polymorphisms [including -1031, -863, -857, -308 and -238] by PCR and RFLP methods. The frequency of the mutant allele of -1031 polymorphism was significantly higher in Iranian patients with Crohn's disease compared to healthy controls [P=0.01, OR=1.92; 95% CI: 1.14-3.23]. None of the other evaluated polymorphisms demonstrated a significant higher frequency of mutant alleles in Iranian IBD patients compared to controls. Among the five assessed [SNPs], only -1031 polymorphism of [TNF- alpha] gene may play a role in disease susceptibility for Crohn's disease in Iran. This pattern of distribution of [TNF- alpha] gene polymorphisms could be specific in this population

[NOD2 novel mutations in Iranian Crohn's patients]

Despite the reported role of three common mutations of the CARD15/NOD2 gene including R702W, G908R and 1007fs in Crohn's disease [CD], only about 30% of Iranian CD patients carry one of these three variants [R702W]. The aim of this study was to screen the hot points of NOD2 gene to find any novel sequence variations in Iranian patients with CD. Eighty non-related Crohn's patients from Iranian origin, referred to a tertiary center in a three-year period [2006-2009], were enrolled in this study. The hot points of NOD2 gene [including exons 4 and 8] were evaluated by direct sequencing after amplification of related sequences with polymerase chain reaction [PCR]. A total of 17 sequence variations were identified among these exons of NOD2 gene including 7 novel ones. Three of these new mutations had an allele frequency more than 5%. All new mutations were a consequence of a single nucleotide change, 4 resulted in an aminoacid change while one formed a stop coden. No deletion or insertion mutation was observed in this part of the gene. This study demonstrated the existence of uncommon NOD2 variants in Iranian patients with CD. It is possible that these mutations play a role in susceptibility to CD in Iranian population

surgical management of complicated pulmonary hydatid cysts

Iran is recognized as an endemic area for lung hydatids. Surgical removal of some hydatid cysts may have srious morbid consequences. To determine the characteristics of these special cysts, a retrospective survey was carried out on patients admitted to Modarres Hospital in Tehran between 1989 and 1998. We have found that reptured, bilateral, lung located, and giant cysts [>10 cm] cause more surgical and anesthetic complications, thus we named them "complicated cysts". Of 110 patients, 62[56.4%] had complicated hydatid cysts. Of these, 2 individuals died during anesthesia induction because of hypoxemia. Since sudden severe hypoxemia did not respond to all essential measures, the patients were returned to the supine position [from lateral decubitus position], then rigid bronchoscopy was performed for drainage of cyst secretions and fragments of laminated membrane. At the time of induction of anesthesia, the contents of a ruptured cyst may spill into the airway and cause hypoxemia and even death. In order to prevent this complication, two different approaches were used: [1] A chest tube was introduced into the cyst through the chest wall and its contents were drained; [2] Patients were placed in the sitting position during intubation. Double lumen endotracheal tube [DLT] may allow salvage of unaffected lung from inadvertent leakage of cyst contents or laminated membrane emboli formation, but it does not guarantee asafe operation. Thus, rigid bronchoscopy should always be available. Cystostomy was the most common surgical technnique performed in our center [80%]. Massive air leakage, bronchial fistula, and permanent lobar collapse were the main indications for lung resection in our series. Surgical complication rates of our study were higher than reports from the west. Coordination and cooperation of experienced surgeous and anesthetists can result in better outcomes following complicated cyst removal