diagnostic value of surface markers in acute appendicitis; a diagnostic accuracy study

Objective: To determine the diagnostic value of blood cells surface markers in patients with acute appendicitis

Methods: In this cross-sectional study, 71 patients who underwent appendectomy following a diagnosis of appendicitis were recruited during a one-year period. The patients were divided into two groups: patients with histopathologically confirmed acute appendicitis and subjects with normal appendix. Blood cell surface markers of all patients were measured. Univariate and multivariate analytical methods were applied to identify the most useful markers. Receiver operating characteristics [ROC] curves were also used to find the best cut-off point, sensitivity, and specificity

Results: Overall we included 71 patients with mean age of 22.6 +/- 10.7 years. Of the 71 cases, 45 [63.4%] had acute appendicitis while 26 [36.6%] were normal. There was no significant difference between two study groups regarding the age [p=0.151] and sex [p=0.142]. The initial WBC count was significantly higher in those with acute appendicitis [p=0.033]. Maximum and minimum area under the ROC curve in univariate analysis was reported for CD3/RA [0.71] and CD38 [0.533], respectively. Multivariate regression models revealed the percentage of accurate diagnoses based on the combination of gamma/delta TCR, CD3/RO, and CD3/RA markers to be 74.65%. Maximum area under the ROC curve [0.79] was also obtained for the same combination

Conclusion: the best blood cell surface markers in the prediction of acute appendicitis were HLA-DR+CD19, alpha/beta TCR, and CD3/RA. The simultaneous use of gamma/delta TCR, CD3/RA, and CD3/RO showed the highest diagnostic value in acute appendicitis

Model Determination of Delayed Causes of Analgesics Prescription in the Emergency Ward in Arak, Iran

BACKGROUND: According to the reports of the World Health Organization 20% of world population suffer from pain and 33% of them suffer to some extent that they cannot live independently. METHODS: This is a cross-sectional study which was conducted in the emergency department (ED) of Valiasr Hospital of Arak, Iran, in order to determine the causes of delay in prescription of analgesics and to construct a model for prediction of circumstances that aggravate oligoanalgesia. Data were collected during a period of 7 days. RESULTS: Totally, 952 patients participated in this study. In order to reduce their pain intensity, 392 patients (42%) were treated. Physicians and nurses recorded the intensity of pain for 66.3% and 41.37% of patients, respectively. The mean (SD) of pain intensity according to visual analogue scale (VAS) was 8.7 (1.5) which reached to 4.4 (2.3) thirty minutes after analgesics prescription. Median and mean (SD) of delay time in injection of analgesics after the physician's order were 60.0 and 45.6 (63.35) minutes, respectively. The linear regression model suggested that when the attending physician was male or intern and patient was from rural areas the delay was longer. CONCLUSIONS: We propose further studies about analgesics administration based on medical guidelines in the shortest possible time and also to train physicians and nurses about pain assessment methods and analgesic prescription.

Prevalence of Helicobacter pylori infection in Arak, Iran during 2011

Helicobacter pylori [H. pylori] is a global pathogen with a widely varied prevalence [30%-80%] among different countries and populations. This study aims to determine the prevalence ofH. pylori in the population of Arak, Iran. This was an epidemiologic cross-sectional population-based study with multistage sampling. The population of Arak according to the 2006 census was 615,722 [493,845 urban and 121,857 rural residents]. In this survey, five urban and four rural Health Service Centers were randomly selected. The study population was divided between these centers based on the population of individuals covered by these centers. Subsequently, clustered samples were randomly chosen according to Health Care Unit Family Codes and the Right Hand Rule. After obtaining informed consent and completion of a demographic questionnaire, 5 cc of venous blood was taken from each participant for theH. pylori IgG antibody test. In this study IgG antibody against H. pylori was measured by ELISA. Of 1187 participants, 1150 [853 urban and 297 rural] completed the study. Overall, 673 [58.5%] were positive for H. pylori. The prevalence of H. pylori infection increased with age from 43.9% among those<20 years old to>70% in participants over 50 years old [p=0.002]. A total of 57% urban samples and 63.3% rural samples were H. pylori positive [p=0.028]. There was no relationship between H. pylori infection and education level [p=0.37], career [p=0.39] and income, [p=0.29] in either the urban or rural areas [p=0.64 [education level], 0.48 [career], and 0.57 [income]]. Our study showed a lower prevalence ofH. pylori compared to some Asian countries, however this prevalence was more common than Western countries. Using disinfected tap water in both urban and rural areas in addition to improved access to general health care might have a role in this relative lower prevalence

Parents function and behavioral disorders in children with and without diurnal voiding dysfunction: a comparative study

Diurnal voiding dysfunction is one of the most common causes of pediatric urology clinic admissions. It can cause behavioral problems for children and their parents. We lunch this study to compare the parents' function and children's behavior problem in pediatric patients suffering from diurnal voiding dysfunction referring Arak Amir Kabir hospital. To perform this case-control study, we recruit 116 children with diurnal voiding dysfunction and compared them with other 116 children non-affected children aged between 5 to 16 years old. The child behavior checklist [CBCL4/18] for children behavior assessment and Global Assessment of Functioning [GAF] for the evaluation of their parent's behavior were completed by the parents. Data was analyzed using ANOVA, qualitative variables and CHI[2] formula. Among 116 patient with voiding dysfunction, 10 case [8.6%] showed behavioral problem while this figure was 3 case [2.6%] in the control group, denoting a significant difference [p=0.04]. Moreover 20 children [17.2%] in the case group and 9 children [7.8%] in the control group had internalizing problem [p=0.02]. Twenty two children [19%] with voiding dysfunction and 8 children [6.9%] in the healthy group had externalizing problem which was also a significant difference [p=0.01]. As a significant difference [0.01], the parent's average stress and behavior scores in case and control group were 3.65 and 3.76, respectively. The higher prevalence of behavioral problem in the children suffering from diurnal voiding dysfunction and their parent's functional impairment highlights the importance of early parent's intervention for early treatment and subsequently prevention of future behavioral problem in their sibling