Combined blood and pleural levels of mesothelin and osteopontin for the diagnosis of malignant pleural mesothelioma

Malignant pleural mesothelioma [MPM] is a highly aggressive tumor with poor survival rate. It is difficult to diagnose MPM at an early stage. Soluble mesothelin remains the best available biomarker for MPM, however the lack of sensitivity for early stage disease provides a motivation for the search of an additional marker that could be combined with mesothelin for early malignancy detection. The aim was to evaluate the diagnostic value of soluble mesothelin and osteopontin both in blood and pleural fluid of MPM patients and to assess whether combination of these markers could improve the diagnostic accuracy of mesothelin. In this study mesothelin and osteopontin were measured by ELISA method in 197 samples [123 blood and 74 pleural] obtained from 123 participants, divided into 4 groups: 38 MPM patients, 24 patients with metastatic pleural effusion [Mets] of various carcinomas, 29 patients with hydrothorax and 32 healthy asbestos exposed subjects. Receiver operating characteristic [ROC] curves were generated to compare the diagnostic capability of these biomarkers. Combination of markers was done through logistic regression analysis. The median blood and pleural levels of the two markers were significantly higher in MPM patients than in hydrothorax or asbestos exposure groups [P < 0.0001], however the difference between MPM and Mets group was not significant. Combining the data from blood mesothelin and osteopontin using logistic regression model raised the area under the ROC curve [AUC] from 0.774 for serum mesothelin and 0.828 for plasma osteopontin to 0.867 to differentiate MPM from hydrothorax and asbestos exposed subjects. Combining the diagnostic capability of both pleural markers raised the AUC from 0.871 for pleural mesothelin and 0.847 for pleural osteopontin to 0.905 to differentiate MPM from hydrothorax patients. The performance of serum and pleural mesothelin in diagnosing MPM was improved when combined with plasma and pleural osteopontin [respectively] through logistic regression analysis model. This will be a great advance in screening and management of MPM

Do interns achieve learning outcomes up to faculty members' expectations?

In an era of increasing professional accountability, there is a need for both medical educators and licensing bodies to identify the exit competencies expected from medical graduates. Pediatrics department of Isfahan University of medical sciences has defined learning outcomes that should be achieved in pediatric ambulatory setting and both learners and teachers were informed about these outcomes. The aim of this study is to compare faculties' expectation and interns' self-assessment about their achievement of learning outcomes at pediatric out-patient clinics. In this cross-sectional study conducted in October and November 2005 a list of 63 learning outcomes was prepared. In the first phase, all faculty members were asked to specify desired level of achievement on 0-3 analogue scale for each outcome. In second phase, interns were acquired to self evaluate their level of achievement in these competencies based on the above scale. In this study 53 interns and 6 faculty members participated. Interns were expected to be fully competent with respect to eleven learning outcomes. There was a significant difference between faculties' expectations and interns' self assessment in 6 of full competency requiring outcomes and in 13 of high competency requiring outcomes. Interns' achievement seems unsatisfactory regarding outcomes requiring full and high competency achievement and pediatrics department can revised its curriculum based on the results of this study and improve teaching and learning in the outpatient services

CPR education before internship

The importance of training basic and advanced life support for undergraduates and graduated physicians are now widely recognized. Graduates of medical schools in Iran immediately get license to practice medicine without any supervision. Therefore, Clarification of the best phases for training CPR and the optimum mastery level in each phase is very important. This study is an attempt to find out the ideas of stakeholders about training CPR before internship, the experience needed at the beginning of internship, the best phase for training it and the assessment method. It is a survey study designed in Isfahan University of Medical Sciences to investigate the opinions of head-nurses, interns, residents and educational directors [in ten clinical departments/ wards] about training CPR before internship. Respondents completed self administered anonymous questionnaires. The questionnaires' items covered opinions of respondents about CPR as interns' duty level of experience; best course for training and the assessment method. Meanwhile, views of participants were compared against educational directors' idea by Fisher exact test. 32 head-nurse, 285 interns, 13 resident and 15 educational directors participated in the study and all agreed with CPR as interns' duty in all clinical wards. Although, directors had different idea about level of experience for CPR to be achieved by interns, residents suggested level 3 of experience. According to the results externship is the best phase for CPR training and combination of observation and OSCE suggested as the best assessment method. To prepare the graduates achieving full competency in CPR performance, it is needed to implement training programs before internship. Internship is the best phase for getting expertise in CPR. Based on the results CPR considered as interns' responsibility and medical schools should feel confidence about the competency of interns in CPR at the beginning of internship

Usefulness of thrombopoietin and IL-6 serum levels in thrombocytopenic newborn

Thrombocytopenia remains a common problem in sick newborns. A quarter of all neonates admitted to neonatal intensive care units develop thrombocytopenia and in 20% of neonatal bleeding episodes, the thrombocytopenia is severe [platelets < 50.000/mm[3]]. Thrombopoietin [TPO] regulates platelets production stimulating megakaryocyte prolieration and mutation. Interleukin 6 [IL-6] is one of the most potent thrombopoietin cytokines. Establishment of thrombopoietin and IL-6 serum levels in healthy and thrombocytopenic neonates is an important step in further understanding of the pathophysiology of neonatal thrombocytopenia. We measured circulating TPO and IL-6 in groups of neonates with thrombocytopenia to find out if mey have a role in thrombopoiesis and to determine their value in diagnosis of several of thrombocytopemu. One hundred and five newborns with thrombocytopenia [47 fullterm and 58 preterms] were the study population. Their ages ranged between 1 and 29 days [2.8 +/- 4.5]. Thirty age and sex - matched healthy newborns constitute the control group. Half of them were preterm and other half were fullterm. Serum TPO and IL-6 levels were measured by enzyme-linked immunoassay [ELISA]. Thrombocytopenia patients had higher serum TPO and IL-6 levels [575.04 +/- 430.7 pg/ml, 112.83 +/- 128.83 pg/ml respectively] than the control group [301 +/- 112.48 pg/ml, 61.9 +/- 73.28 pg/ml] and the difference was statistically highly significant [p < 0.001]. TPO and IL-6 serum levels showed positive significant correlation [r =0.25. p = 0.003]. In thrombocytopenia neonates, the lower the platelet count, the higher the serum TPO concentration. The differences for serum Il-6 levels in fullterm and preterm thrombocytopenic neorates when compared to healthy fullterm and preterm controls were statistically significant [P = 0.02, 0.007 respectively] while those for serum TPO levels gave insignificant results [P = 0.3 and 0.07]. Thrombocytopenic neonates with sepsis had higher and significant TPO and IL-6 serum levels than thrombocytopenic neonates with other etiologies and controls [633.68 +/- 406.58, 333.04 +/- 203.39, P < 0.0001]. Measurements of serum TPO and IL-6 levels provide valuable diagnostic information for the analyses of thrombocytopenia in neonatal infants

Allergenic pollen in the atmosphere of Kayseri, Turkey.

Airborne pollen are important allergens that cause sensitization in allergic rhinoconjunctivitis and asthma. Our aim was to detect the pollen in the atmosphere of Kayseri, to present a pollen calendar, and to detect the allergenic level of these pollen by performing skin tests on patients. Atmospheric pollen were collected by Durham gravimetric samplers in Kayseri between March and November in the years 1996 and 1997. In our study, we observed pollen belonging to 43 different taxa. The total number of pollen per cm2 was found to be 1,330.8 in 1996 and 1,182.5 in 1997. Most of the pollen were from the taxa Pinus, Poaceae, Chenopodiaceae/Amaranthaceae, Cupressaceae, Populus and Quercus in decreasing order. In the skin tests, pollen of the taxa Poaceae and Chenopodiaceae were found to give the most frequent allergic reactions. It was concluded that preparing an airborne pollen calendar could be useful for medical practice. Nevertheless the skin test data did not really correlate with the aerobiologic data, as skin test reactivity is related to the allergenicity of the pollen and not just to ambient exposure.

role of MMP2 and nm23H1 in predicting the aggressiveness and lymph node metastasis in laryngeal carcinoma

we examined the degree of expression of both MMP2 and nm23 H1 proteins in 24 cases with primary laryngeal carcinoma using immunohistochemistry and correlated the results with the clinical, radiological and histopathological data, in order to evaluate their role in predicting the local spread and/or lymph node status. Preoperative clinical evaluation of these patients included; a full history taking, thorough ENT and neck examination and direct laryngoscopy. Radiological assessment via CT neck thin axial cuts was done. Then laryngeal and nodal specimens were examined histopathologically and immunohistochemically for nm 23H1 and for MMP2 proteins. There was a significant correlation between MMP2 expression and the site of the tumor since much lowering of MMP2 was mainly associated with glottic carcinoma [P<0.05]. Concerning the tumor stage, advanced tumor stages were associated with increase in MMP2 expression, yet it didn't reach statistical significance [P0.07]. However, the presence of lymph node metastasis was significantly related to excess expression of MMP2 [P<0.05]. As regard nm23Hl, a statistically significant correlation was found between nm3H1 expression and tumor stage [P< 0.05]. Moreover, the presence of lymph node metastasis was significantly correlated to the loss of nm23H 1 expression and vice versa [P<0.05]. But correlating the expression levels of MMP2 and nm 23H1, it was statistically insignificant [P >0.05]. Although MMP2 and nm23Hl were correlated to the aggressiveness of malignancy, yet the statistical correlation of their expression levels were statistically insignificant [P >0.05]. Collectively, MMP2 increased expression was related to the occurrence of nodal metastasis of the tumor and also to the tumor sites characterized by frequent metastasis [supraglottic and transglottic]. On the contrary, nm23Hl expression was inversely related to the advancement of tumor stage and the nodal metastatic state

Management of osteomas of the nose and paranasal sinuses

Craniofacial osteomas are benign tumors of the skull base, often involving the nose and paranasal sinuses. The aim of the present study is to compare different approaches in the management of osteomas of the nose and paranasal sinuses. In this study 20 patients were treated for osteomas within the nose and paranasal sinuses. All patients had standard radiological studies and computed tomography with coronal and axial cuts of the nose and paranasal sinus. Four cases were Asymptomatic and so managed conservatively. Surgery was done for 16 symptomatic cases. We used endoscopic approach in 8 out of 16 symptomatic patients. Endoscopic and radiological follow-up ranging from 6m to 24 months was done postoperatively. In our study we found that nasoendoscopic approach allows closer and more direct visualization during surgical removal of osteoma and with the aid of the intranasal drill for osteoma fragmentation and root separation, hemorrhage was more easily controlled, and extensive excision was minimized, with no cosmotic complications occurred

Hydatid cyst of lung confrontation surgery-serology

Because the serology keep's a place in the diagnosis of hydatid cyst of lung with radiology, different techniques are used: Complement fixation technique; electrosyneresis, agglutination, indirect immunofluorescence, Elisa, Immunoblot assay. However, their specificity and their sensitivity are not identical, and can lead to discordant results. In this study, we have compared the serological techniques results with surgical results. 44 patients were tested between 63, observed in pneumology service during 4 years [1997-2000]. For the sensitivity, Elisa[IgG] and immunofluorescence are positive in 23 patients [65%], and negative in 12 patients [34%] [the doorstep of sensitivity for Elisa[IgG] is fixed from DO=0.3]. The Elisa[IgA] is positive in 12 patients [34%], and negative in 23 patients [65%] [The doorstep of sensitivity is fixed from DO=0.2]. The electrosyneresis is positive in 16 patients [46%], and negative in 19 patients [54%]. We have the same results with literature knowing that in hydatid cyst of lung the sensitivity is low. For specificite, only Elisa[IgG] has a false positivity in two case: Thymoma and carcinoma with a low level [400-200]. This results show that the serological techniques keep's their place for the diagnosis of hydatid cyst of lung in spite of the lack of sensitivity and specificity. This lack can be compensed by using Immunoblot assay

effect of lormetazepam and midazolam on some monoamines and amino acid levels in the brains of guinea pigs

The effect of lormetazepam and midazolam on norepinephrine, dopamine, gamma-amino-butyric acid [GABA], L-glutamic acid and their enzymes were investigated in both acute and chronic experiments. A significant decrease in the levels of norepinephrine and dopamine was observed in midazolam group in acute and chronic studies, while an insignificant change was observed with lormetazepam. Both drugs caused a significant increase in GABA and glutamic acid decarboxylase in L-glutamic acid and gamma-aminobutyric alpha ketoglutaric transaminase activity [GABA-T]