[Morphology of red blood cells for differentiating between the upper and the lower urinary tract infection]

Accurate differentiation between upper and lower urinary tract infection [UTI] requires invasive produces. The objective of this study was to determine the morphology of RBC that originates from kidney or bladder for differentiating between upper and lower urinary tract infection. UTI was induced by the injection of 0.5ml of normal saline containing human E coli [10[4]/cc] into the bladder of rats [n=50]. After 48 hours, the rat urine was drained from the bladder and analyzed for the morphology of RBC, culture and cell counter. For diagnosing pyelonephritis, both bilateral kidneys and bladder were biopsied for histopathology and culture. Dysmorphic RBC was detected in 33% [10/30] of the subjects with upper UTI and 13% [4/30] with lower UTI, which showed no significant difference [x[2] =0.04, P=0.63 Fisher Exact Test]. The mean and SD of percentage of dysmorphic RBC in the subjects with upper and lower UTI were 35 +/- 34% and 44 +/- 43%, respectively, which revealed no significant difference [t=0.55, P=0.25]. In this study, dysmorphic RBC showed rates of 45% sensitivity and 50% specificity for upper UTI diagnosis. Urine osmolality may influence the results of RBC morphology for differentiating between upper and lower UTI

[Frequency of antigliadin and anti-transglutaminase in patients with irritable bowel syndrome]

On one hand the prevalence of Irritable Bowel Syndrome [IBS] ranges from 4 to 12 percent in the community; on the other hand, Celiac disease is prevalent in 4% of the IBS patients. Regarding the fact that cereals containing gluten are routinely used in Iran, diagnosing celiac disease in IBSpatients is important for conducting the treatments. The objective of this study was to assess the frequency of Celiac in IBS patients. This study was designed as a case control prospective study. Eighty six subjects were enrolled in this study according to Rome II Criteria. The control group included healthy subjects that were checked up on a routine base. The evaluation of Celiac was done through serology exams such as Anti Gliadin and Anti Transglutaminase [IgG and IgA]. Thirty eight male and 48 female patients suffering from IBS with a mean age of 34 +/- 11.7 years were enrolled in this study. The case and control groups were not significantly different in terms of sex and age. Flatulence, excessive gas passing and mucus passage were the most frequent symptoms in IBS patients. Night symptoms and weight loss [alarm signs] were observed in 37% and 32%, respectively. Elevated Antigliadin Titer was evident in 22 subjects [25%] which suggests a significantly higher rate for the case group as compared to the control group [t=4.67,P=0.0001]. Elevated IgG Anti Transglutaminase Titer was observed in 2 cases [2.3%] while IgA Anti Transglutaminase was not elevated in any of the IBS subjects, neither in the control group nor in the case group. Biopsy of small intestine can be suggested to rule out the elevated Antigliadin Titer Celiac Disease in IBS patients

[Radiologic findings in Hydatid cyst of lungs]

Hydatid cyst of lungs is mainly diagnosed by imaging procedures such as chest Roentgenogram and chest CT Scan. In endemic area, hydatid cyst may be discovered during the surgery appearing in a form which is not usually identified with typical Hydatidosis of lungs. The objective of this study was to give a description of the most important atypical radiological presentation of lung Hydatidosis. All the patients diagnosed as having pulmonary Hydatidosis through a surgical exploration were included in this study. Standard chest Roentgenograms and computed Tomographies were evaluated before the surgery for diagnosing any lung cyst or unknown lesion. Radiological findings were divided into two categories: 1-Typical Hydatid cysts which have already been described in literature as having imaging presentations such as intact cyst, water lily sign and crescent sign. 2- Atypical Hydatid cysts that do not resemble any feature of typical Hydatid cysts as mentioned above. 1614 subjects who had already been diagnosed with pulmonary Hydatidosis over a period of 28 years went under surgical operations. Seventy nine of them received standard Thoracic CT scan. Atypical cysts were detected in 35% of the subjects that were X-rayed by chest and in 32 of them [40.5%] who received CT Scan. The most frequent chief complaint was coughing as reported by 68 [87%] of the cases. None of the clinical and demographic findings were significantly more frequent in the subjects with atypical Hydatid cyst. The most frequent manifestation illustrated in the radiological pictures was thick cavity wall in 9 subjects [28%]. Other findings were as follows: solid mass in 7 [21%], abscess in 6 [18%], consolidation in 3 [9%], fungus ball in 3 [9%], collapse [atelectasis] in 2 [6%] and round pneumonia in 2 [6%]. Cavity was significantly more frequently seen in the right lung [90%] and mass like opacity was significantly more frequent in the lower lung field [100%]. Hydatid cyst showing atypical features is relatively common; thus, physicians should be cautious about the possibility of Hydatid cyst while evaluating most of the radiological pictures of the lung, no matter what the localization, size and count of the lesion

[ serum and sputum levels of Interleukin - 17 in patients with asthma]

Association of asthma with Type 2 T- helper system is well realized. Recent clinical evidence show that acute, severe exacerbations of asthma are associated with recruitment and activation of neutrophils in the airways. The lymphocytes T helper 17 [Th17] cells can probably recruit neutrophils to an inflammatory site through producing IL-17. The objective of this study was to investigate the level of interlukin-17 [IL-17] in serum and sputum of asthmatic subjects. Also, the study aimed at evaluating the correlation between concentrations of IL-17 and the frequency of inflammatory cells in the sputum of asthma at different stages. Fifty newly diagnosed asthmatics and 12 non-asthmatics healthy subjects, as the control group, entered this prospective study. None of them reported any recent history of infection and steroid usage. Then, samples from venous blood and sputum [Induced by Hypertonic saline%5] were obtained. The severity of asthma was classified according to GINA 2004 guidelines. The Concentrations of IL-17 in serum and supernatant of induced sputum were determined by ELISA method. Total serum IgE level was also determined in order to classify asthmatic subjects into allergic and non-allergic groups. As the findings of the study suggest, serum IL-17 level was significantly higher in asthmatic patients than in the normal control subjects [78.8 +/- 58.7 vs 17.7 +/- 2.4 pg/dl, P=0.025]. IL-17 was found to be significantly increased in sputum of the subjects with asthma, as compared to the control subjects [31.6=/-20.9 vs 21.5 +/- 16.6 pg/dl, P=0.012]. In addition, allergic and non-allergic asthmatic patients showed a significantly higher concentration level of serum IL-17 than the normal controls [80.8 +/- 50.3, P+0.023 and 102.7 +/- 43.6, P=0.002vs 17.7 +/- 2.4 ng/ml]. But, it was found that the levels of both serum and sputum IL-17 in the allergic asthma group were not significantly higher than those in the non-allergic asthmatics. Moreover, serum IgE level was significantly higher in allergic asthmatic patients than non-allergic asthmatic and normal control subjects [295.8=/-168 vs. 99.1 +/- 90.0 P=0.001 and 49.7 +/- 41.8, P=0.001]. The results further revealed that macrophage was decreased in sputum but neutrophil and eosinophil were significantly increased. However, the increase of IL-17 was not correlated with asthma severity. Besides, there was no significant difference between allergic and non-allergic asthmatic subjects, in terms of IL-17. We propose that IL-17 may play a role in the airway inflammation of asthmatics by recruiting neutrophils into the lung, no matter if they are suffering from allergic or non-allergic asthma

effects of chronicity on high resolution computed tomography findings in asthma

Remodeling is the late result of chronic inflammation in untreated asthma. Remodeling causes resistance to classic asthma therapy, but the time required for this change has not been confirmed, yet. High resolution computed tomography [HRCT] is the only noninva sive method to confirm the structural change in the bronchial wall. The objective of this study was to evaluate the frequency of remodeling in chronic asthma as well as determine the proposed time required for developing remodeling. Non smoker asthmatic patients with more than one year of duration who referred to the sub specialty clinic of pulmonary participated in our study. History, physical examination and spirometric evaluation were done. Diagnosis of asthma was confirmed according to GINA guidelines. CT scan of the lungs was performed in a deep inspiration using Phillips Spiral Multi Slice [1.5 mm thickening]. The images were evaluated by two radiologists. The main group was divided in two groups: The patients with more than 5 years of duration of the disease, and those who had been infected with the disease for less than 5 years. The results were then compared with each other. Seventy four subjects participated in this study [40 females, 34 males]. In asthmatic patients with a history of more than 5 years, the mean of age was 51 15.5 years. This group showed no significant difference from the other group with a duration of lower than 5 years [mean age: 45 18.26 years]. The most frequent clinical disorder in both groups was found to be dyspnea [98/6%]. The symptoms found in the subjects with abnormal HRCT were ranking from the most to the least frequent as: bronchial dilation [22, 30%], mosaic pattern [12, 16%]; both bronchial wall thickening and modularity pattern [11, 15%], and emphysema [9, 12%]. HRCT findings were normal in 32% of subjects. Diagnostic criteria of remodeling in subjects with duration of 1-5 years were not significantly different from those in the subjects who were infected for over 5 years. Bronchial dilation and thickening of bronchus are the best criteria for diagnosing remodeling, but remodeling may occur earlier than the expected time

Serum lipid level in obese subjects with body mass index of over 40

According to the definition given by the National Institute of Health, obesity is a chronic disease that may cause some other diseases in humans. Body mass index [BMJ] is used for the evaluation of obesity. Obesity will be considered sever when BMI is over 40. In such cases, lipid disorders could be speculated. The objective of this study was to assess the frequency of lipid disorders in subjects with the BMI of above 40. Two hundred patients with the BMI of over 40 were entered in this prospective study. Their lipid profile including serum total cholesterol, triglyceride, LDL and HDL were determined and correlated with the ratio of BMI and Waist to hip. The effects of other risk factors such as diabetes, pregnancy and osteoporosis on the subjects' lipid were also evaluated. The average age of the obese subjects was 40 years, ranging from 19 to 63. 81% of the subjects were female. The mean level of BMI was calculated as 44.42 +/- 4.4 [40.04-67.62]. Additionally, the mean level of cholesterol, LDL arid HDL were 244 +/- 30.63, 159 +/- 31.22 and 33.95 +/- 2.72 mg/di, respectively As for the mean level of triglyceride, the findings of the study came up with an average of 168.69 +/- 72.16 [72-260]. The frequency levels of abnormal LDL and HDL were found to be 81.5% and 100%, respectively. The avenge ratio of Waist to hip was measured as 0.86 +/- 0.2. 11.5% of the subjects were suffering from diabetes. The findings of the study suggest no significant correlation between diabetes, pregnancy or osteoporosis with BMI. Lipid profile in obese subjects showed abnormal cholesterol, LDL and HDL level that increase the risk of cardiovascular events

Benign fibrous mesothelioma presenting as huge pleural mass

Mesothelioma of pleura is classified as malignant and benign. Benign mesothelioma is less frequent and may diagnose incidentally during routine chest X ray. Symptomatic cases usually show chest pain, dyspnea or cough due to compressive effect of tumor on surrounding tissue. In this article we present a benign fibrous mesothelioma in a female subject with shoulder pain and missed huge pleural mass. She referred because of long lasting dyspnea and chest pain. This subject was operated and complete resection of tumor results in complete resolution of symptoms

Significance of unilateral vocal cord paralysis diagnosed during bronchoscopy

Morphology and movements of vocal cords should be checked during bronchoscopy. In past literature, unilateral vocal paralysis is considered as benign. Evaluation of major underlying disease in patients with unilateral vocal cord paralysis diagnosed during bronchoscopy. A cross sectional case control study design was used to evaluate all patients who underwent bronchoscopy during the year 2003 for various causes. Sample size was 194 patients [0.01 error and 80% potency]. Data including patient's respiratory complaints and radiological findings were gathered in a questionnaire. Bronchoscopy was performed in standard condition using local anesthesia. During procedure, vocal cord movement was examined with appropriate maneuver, and complete study of trachobronchial tree with bronchial lavage was done. Appropriate biopsy was performed when indicated. Specimens were sent for evaluation of AFB, cytology, histopathology and culture for mycobacterium tuberculosis. Unilateral vocal cord paralysis was observed in 10% [19 of total 189 patients who underwent bronchoscopy], Male to female ratio was 3:2 and average age of patients was 65 years [range= 37-76]. Cough was the main complaint in 94%, dyspnea in 100% and hemoptysis in 32%. Smoking was present in 9 patients [47%]. Vocal cord paralysis in left side was predominant and it was seen in 68% [13/19]. Twelve patients [63%] with unilateral vocal cord paralysis had significant lung disease, eight had pulmonary tuberculosis, and four had lung cancer [one SCC, one SmCC, and two undifferentiated carcinoma]. Confirmed lung disorders in case group was significantly more than control group [chi square=4.92; p=0.026; Odd ratio= 2.93, 95% Cl=1.01-8.76]]. In the remaining patients with vocal cord paralysis [7], one had old healed tuberculosis and 5 had chest roentgenogram strongly suggestive of malignancy who were referred for further evaluation. The bronchoscopist should pay special attention to unilateral vocal cord paralysis observed during routine bronchoscopy. We observed significant lung disorders present in 63% of these patients

Mucormycosis of the lung, a rare cause for lung cavitations. case report

Cavitary lung lesion is caused by serious lung pathology. Among rare causes is mucormycosis that should not be overlooked. High index of suspicion is necessary to avoid missed diagnosis especially in diabetic and immunosuppressed patients. We present two cases with lung mucormycosis diagnosis. Case 1: A 58 year old male with history of diabetes, presented with hemoptysis. Chest X ray [CXR] showed cavitation. Bronchial lavage revealed mucor hypha that was proved again with lobectomy. Case 2: A 39 year old female with history of chronic renal failure and lung cavitary lesion due to previous necrotizing pneumonia. She suffered from cough, dyspnea and hemoptysis. Comparison of old and new CT scan showed increasing of cavity thickness. Lobectomy was performed and mucor was proved in histopathology. We present two cases of pulmonary mucormycosis who referred with hemoptysis and other respiratory tract symptoms and lung cavitations. Surgical resection and amphotericin was very successful in their management. We recommend investigation of fungus in BAL fluid or tissue material of patients with cavitary lesion

Anthracosis of the lung: evaluation of potential causes

Anthracosis is black pigment discoloration of bronchi which can cause bronchial destruction and deformity [anthracofibrosis]. A prospective, case-control study was performed to evaluate potential underlying causes of anthracosis on 190 subjects who referred for various indications. Age of patients ranged from 10-85 yrs. 46% of male patients were farmers and 27% were manual workers, whereas 91% of female patients were housewives. During bronchoscopy, special attention was given to anthracotic plaque, bronchial deformity, infiltration, or vegetation. Broncho-alveolar lavage was performed for further cytopathological, acid-fast bacilli staining [AFB] and culture in all cases. No correlation between occupational exposure to dust and two kinds of anthracosis [anthracotic plaque and antracofibrosis] was present. In anthracofibrotic patients, 81% were nonsmokers. The principal finding in bronchoscopy was simple plaque of anthracosis in 21% and anthracofibrosis in 12%. Sputum smear showed macrophages containing anthracotic granules in 71%. Patients with anthracosis had positive histopathology for tuberculosis [21%] that was not significantly different from subjects without anthracosis. Of 40 patients with simple anthracotic plaque and 22 with anthracofibrosis, only two and one patients, respectively were proven to have bronchogenic carcinoma that was not statistically more common than in the control group. Other etiology for anthracofibrosis should be investigated