Bilirubin/albumin ratio for predicting acute bilirubin-induced neurologic dysfunction

The aim of this study was to evaluate the bilirubin albumin [B/A] ratio in comparison with total serum bilirubin [TSB] for predicting acute bilirubin-induced neurologic dysfunction [BIND]. Fifty two term and near term neonates requiring phototherapy and exchange transfusion for severe hyperbilirubinemia in Children's Medical Center, Tehran, Iran, during September 2007 to September 2008, were evaluated. Serum albumin and bilirubin were measured at admission. All neonates were evaluated for acute BIND based on clinical findings. Acute BIND developed in 5 [3.8%] neonates. B/A ratio in patients with BIND was significantly higher than in patients without BIND [P<0.001]. Receiver operation characteristics [ROC] analysis identified a TSB cut off value of 25 mg/dL [area under the curve [AUC] 0.945] with a sensitivity of 100% and specificity of 85%. Also, according to the ROC curve, B/A ratio cut off value for predicting acute BIND was 8 [bil mg/al g] [AUC 0.957] with sensitivity of 100% and specificity of 94%. Based on our results, we suggest using B/A ratio in conjunction with TSB. This can improve the specificity and prevent unnecessary invasive therapy such as exchange transfusion in icteric neonates

Assessing the prevalence of HIV among Afghan immigrants in Iran through rapid HIV testing in the field

Throughout the world, many migrant and mobile populations are at elevated risk for HIV. Iran has a large immigrant population from neighboring Afghanistan; however, few data exist on the prevalence of HIV in this community. In 2008, we conducted a study to assess the presence of HIV infection among 477 immigrants in a town to the northeast of Tehran using a rapid test in the field. HIV prevalence was 0.2% [95% CI 0.005-1.2] with one person HIV-positive. We recommend periodic HIV sero-surveillance with detailed behavioral measures for this population in the future

Low level laser therapy in management of chemotherapyinduced oral mucositis: prophylaxis or treatment?

Chemotherapy-induced oral mucositis [COM] is a common, debilitating complication of cancer therapy. The aims of this study were to evaluate the effect of low level laser therapy [LLLT] on prevention of COM in patients with hematologic malignancies. Fifty-five patients hospitalized to undergo chemotherapy in Imam Hospital were included into the study. These patients were divided into two groups. The oral cavity of the patients were illuminated by continues laser beam using a GaAlAs laser device with wavelength of 630 nm, power output 30 mW, and dose of 5 J/cm2 for six days [LLLT group]. The patients in the second group underwent placebo irradiation [power output equal to zero] with the similar protocol. The severity of the COM was clinically evaluated based on WHO grading scale. The patientys' quality of life was assessed before and after the intervention according to EORTC QLQ-C30 questionnaire. The incidence of COM in LLLT group [31%] was less than the placebo group [41%]. Mean duration of COM healing was 4.8 and 12 days in LLLT and placebo groups, respectively [p=0.03]. Xereostomia was significantly less severe in LLLT group in comparison with the placebo group [p=0.007]. Conclusion: Our findings showed that LLLT significantly reduced the incidence of oral mucositis of WHO grade 3 and 4 as the most debilitating form of oral mucositis, in which oral alimentation is impossible. Also, LLLT could reduce duration of oral mucositis, decreased the risk of secondary infection, and accelerated return to normal nutrition

Respiratory complications in Iranian hospitalized patients with HIV/AIDS

The respiratory tract has been the most commonly affected site of illness in HIV-infected patients. The current study was done to identify the frequency of respiratory complications in a consecutive case series of HIV-positive patients in Iran. This study was a retrospective analysis at the national academic reference medical center of Imam-Khomeini Hospital, in Tehran, Iran. The study included 199 new admissions for 177 HIV-infected patients between 2000 and 2005. Demographic characteristics, risk factors for HIV infection, respiratory complications, and CD4+ lymphocyte counts were evaluated in these patients. All patients were males. The mean age was 35 years [age range: 15 to 63 years]. Among 34 cases with available CD4+ lymphocyte count results, 70.6% had results <200 cells/mm[3]. Nearly half the patients [47.7%] had respiratory symptoms. The most common pulmonary complications were cough [86.3%], sputum [71.6%], dyspnea [54.7%], and hemoptysis [10.5%]. The most common diagnosis was pulmonary tuberculosis [27.1%], followed by other bacterial pneumonias [16.6%] and pneumocystis carinii pneumonia [4.5%]. Intravenous drug users who had history of incarceration had the highest risk factors for Mycobacterium tuberculosis infection [59%], and other bacterial pneumonias [52%].Our study demonstrates that respiratory complications are highly frequent in HIV patients in Iran and that pulmonary tuberculosis is still a common complication in HIV infected patients, despite the availability of effective treatment. Results suggest the need for more effective preventive and prophylactic measures, wider use of antiretroviral treatment and effective chemotherapy for Iranian patients with HIV/AIDS