validity of ultrasound in diagnosing hypertrophic pyloric stenosis

To evaluate the validity of ultrasound for diagnosis and exclusion of pyloric stenosis in the infants with nonbilious vomiting. In a cross-sectional study, 444 consecutive infants with clinical suspicion of pyloric stenosis were evaluated by ultrasound [US] and categorized as pyloric stenosis or not according measuring parameters as muscle thickness, muscle width and canal length of pylorus. Positive findings were confirmed at surgery; Negative findings were confirmed by means of follow up. Sensitivity, specificity and accuracy were calculated. Sensitivity, specificity and accuracy of ultrasound were 100% if pyloric muscle thickness of >3mm was chosen as diagnostic. When muscle thickness more than 4mm was used, sensitivity, specificity and accuracy were 96%, 100% and 99.32% respectively. Ultrasound is highly sensitive and specific if pyloric muscle thickness 3 mm is used as cut off point. By virtue of direct visualization of the pyloric muscle, ultrasound is method of choice for both the diagnosis and exclusion of pyloric stenosis in infants

Home based training: main strategy of community based rehabilitation in Iran

Study of effectiveness of "home based training" in community based rehabilitation program on disabled people, who were trained and evaluated at the end of the course, under supervision of 21 pilot health and medical networks. In a cross-sectional study, 614 disabled people who had participated in "home based training" were selected with stratified random sampling method. They were evaluated according to function progress level variables by community based rehabilitation program experts. Age groups, sex, disability groups, employment state and teacher's relation variables were studied from their files and recording data. Statistical analysis was performed with Chi-square test. There was a relationship between age group and disability group with functional progress level [P value =0.014 and P value <0.001]. Low age groups, visual disabled group, epileptic patients and individuals with learning disability had the best results. High age groups, mixed age disability group and individuals with verbal and hearing problems had the least favorable results. There was a relationship between teacher's relation with progress or no progress state [P value = 0.038]. Individuals that were teachers had the best results and individuals with teachers other than first or second relation or health worker had the least favorable results. Home based training in community based rehabilitation program is an effective method for improving the functions of disabled people in some selected groups

Earlobe crease and coronary artery disease

Diagonal ear lobe crease [ELC] has been introduced as a diagnostic physical sign for coronary artery disease [CAD] and the aim of this study was to evaluate the association between ELC and CAD in Iranians. In a cross- sectional study, 106 consecutive patients, referred from cardiologists for angiography, were studied for presence of ELC and CAD in four academic hospitals in Tehran. ELC categorized based on Ishii classification and CAD defined as at least 50% narrowing in one of the three major epicardial vessels. The average age in 70 men and 36 women was 50.14 +/- 14.11 years. Based on angiographic results, patients were divided in two groups. In 57 patients of CAD positive group, 34 patients had ELC and in 49 patients of CAD negative group only 13 patients had ELC. [P<0.05] After adjusting for age, ELC was a significant predictor of CAD [P<0.05]. The severity of ELC [size and unilateral or bilateral] was significantly related to presence of CAD [P<0.05]. The observed sensitivity, specificity, positive predictive value and negative predictive value of ELC for diagnosis of CAD were in the following order: 59.6%, 73.5%, 72.3% and 61%. In Iranians, the presence of ELC is associated with CAD

Ceftriaxone induced biliary pseudolithiasis in children: report of 14 cases

Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. In this study we evaluated children with ceftriaxone associated pseudolithiasis that was discovered incidentally in US examination. The study includes 14 children with gallstones in Ultrasound without biliary symptoms with recent ceftriaxone administration. All of them were treated for suspected or definite bacterial infection with ceftriaxone 50-100mg/kg/day divided into 2 equal intravenous doses under conditions of adequate hydration. There were no other known underlying diseases for gallstone. Fourteen patients [11 boys and 3 girls] with mean age of 4.5 years [range: 2 months to 14 years] were studied. Following cessation of treatment with ceftriaxone, a complete resolution of the lithiasis was seen in most of followed cases. All patients were free from biliary symptoms [Right upper quadrant pain, Cholestasis] during observation. Consultations with surgeon or subspecialist due to reported "gallstone in the Ultrasound" were performed in about two-thirds of patients. Development of pseudolithiasis after ceftriaxone administration is not uncommon and should be known by pediatricians and radiologists in order to avoid unnecessary surgery or additional consultations