Comparison of tuberculin skin test result and interferon gamma response to human PPD in BCG scar positive and negative children

The aim of this study is to compare Tuberculin Skin Test [TST] result and interferon gamma response to human PPD [purified protein derivative], in scar positive and scar negative BCG-vaccinated children. Between August 2007 and May 2008 a total of 236 children aged 1-168 months [mean 21 months] admitted to Mofid Children's Hospital, Tehran, Iran, were enrolled in a cross-sectional study. Each patient was examined for BCG vaccine scar and tested with TST and human PPD-based Interferon Gamma Release Assay [IGRA]. Two hundred and twenty one cases out of 236 [44% female, 1-168 months, mean age 21 months] were scar positive of whom 95% TST result was negative. Human PPD-based IGRA was positive in 110 [49.8%], negative in 85 [38.4%] and indeterminate in 26 [11.8%] of scar positive patients. Fifteen children [40% female, 1-156 months; mean age 42 months] were scar negative. All the scar negative cases were TST negative. Human PPD-based IGRA was positive in 10 [66.7%], negative in 4 [26.7%] and indeterminate in 1 [6.7%] of scar negative patients. Immune responsiveness to human PPD antigens in scar positive and negative children may not correspond with results of the Tuberculin Skin Test

[Accuracy of panoramic radiographs in determining the relationship of posterior root apices and maxillary sinus floor by Cone-Beam CT]

It is crucial to verify the relationship between root apices and maxillary sinus floor in some surgical procedures like extraction and implant placement or in orthodontic movements like intrusion. Protrusion of roots into the sinus increases the risk of post extraction pneumatization which in turn decreases the available bone at the implant or denture sites. The aim of this study was to determine the panoramic radiology accuracy for defining the relationship between posterior root apices and the maxillary sinus floor by Cone Beam CT [CBCT]. Paired panoramic radiographs and CBCT images of 117 subjects were examined. 452 posterior maxillary roots including second premolar, first and second molar were classified by the means of the relationship with maxillary sinus floor. CBCT was used as Gold standard method, and the agreement of panoramic findings with CBCT was examined statistically. Data were analyzed using Chi-square and Multiple logistic regressions. Agreement of the panoramic and CBCT results were seen in 57.7% of all cases. Roots which had no contacts with the sinus floor [class 0] showed a high agreement of 89.5% between two imaging techniques. Roots in contact with sinus floor [class 1] showed 58.8 % and cases with root protrusion into sinus cavity [class 3, 4] showed 50% of agreement [P<0.001]. Also in 36% of cases with no protrusion into the sinus cavity [class 0, 1, 2], panoramic showed protrusion. The agreement for the premolar was higher than molars [P<0.001]. The majority of roots which their images were projected on the sinus cavity had no vertical protrusion in CBCT cuts. Considering the results, in these cases CBCT can be recommended

Detection of serum antibodies against measles, mumps and rubella after primary measles, mumps and rubella [MMR] vaccination in children

In Iran, the measles, mumps and rubella vaccine [MMR] is administered in a two-dose protocol where the first dose is scheduled at 12 months of age. This study aims to determine the efficacy of the MMR vaccine by testing IgM and IgG antibody levels 4 - 7 weeks after primary vaccination. A single group cohort study was performed on healthy children, 12 - 15 months of age, who were vaccinated at health centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran, from January to April 2009. Children with negative vaccination and/or clinical history for measles, mumps or rubella were administered the first dose of the MMR live attenuated vaccine. IgG and IgM antibodies were checked by enzyme linked immunoassay [ELISA] in serum samples 4 - 7 weeks after vaccination. A child was considered seropositive if antibody levels were higher than the assay cut-off level set by the ELISA kit. Samples from 240 children were checked for antibodies against measles and rubella. Measles serum IgM level was positive in 71.7% of samples and IgG in 75.8%. The rubella serum IgM level was positive in 71.7% of children and IgG in 73.8%. From 190 blood samples that were checked for mumps antibodies, serum IgM was positive in 68.9% and IgG in 95.3%. No significant relationship was found between seropositivity and age or gender. IgG and IgM antibody levels were below the assay cut-off levels against measles and rubella in approximately one-fourth of the children following primary MMR vaccination. A second dose was necessary to raise the level of protection against measles and rubella

[ comparative study of streptococal infection in children with PANDAS: a case-control study]

Recent evidence suggest that group A beta-hemolytic streptococcal [GABHS] infection may increase the risk of pediatric autoimmune neuropsychiatric disorders [PANDAS] composed of the clinical signs of obsessive-compulsive and attention deficit hyperactivity disorders. The objective of this study was to compare the titer of antibodies against GABHS between children with PANDS and the controls. This cross-sectional, case-control study was done in Hazrat Rasoul Hospital, in Tehran, Iran during 2008-2010. We compared serum antibodies streptolysin O, deoxyribonuclease B, and streptokinase against GABHS quantitatively in 79 cases with PANDAS and 39 age-matched controls. The area under ROC curve, sensitivity, specificity and positive predictive value [PPV] of tests were calculated. Most cases were studied in summer [57%] and spring [23%]. The three aforesaid antibodies were higher in the cases [P=0.001]. Antisterptolysin O [cut-off point 195] had a 90% sensitivity, 82% specificity and a 92% PPV, [CI=95%, 0.99-0.91]. Anti streptokinase [cut-off point 223] had an 82% sensitivity, 82% specificity and a 95% PPV, [CI=95%, 0.934-0.735]. Anti-DNase [cut-off point 140] had an 82% sensitivity, 82% specificity and a 95% PPV, [CI=95%, 0.99-0.91]. The study demonstrated a possible role for streptococcal infection in PANDAS. We found a significantly higher antibody titer against GABHS in OCD and ADHD cases in comparison with healthy children. Treatment of streptococcal infection is achievable by the use of long-acting penicillin. Use of aggressive treatment schedules like plasmaphresis, IVIG, etc needs further RCT studies

Evaluation of current guthrie TSH cut-off point in Iran congenital hypothyroidism screening program: a cost-effectiveness analysis

The threshold of thyroid-stimulating hormone [TSH] in current screening for congenital hypothyroidism [CH] from the heel prick test is 5 mU/l. This study uses cost-effective analysis to evaluate increasing the threshold to minimize false-positive results and recall rates. Cost of screening, diagnosis and treatment, education, and care of mentally retarded patients were gathered from the Ministry of Health State Welfare Organization and Department of Education in Tehran. Screening data were obtained from 34,007 neonates in the Central Health Laboratory of Tehran University of Medical Sciences in 2009. Sensitivity analysis and calculation of confidence interval for incremental costs and effects [gained disability adjusted life years - DALYs] and incremental cost-effectiveness ratios [ICER] were performed by Monte Carlo simulation with Ersatz software. ICER for screening programs with different TSH cut-off points versus no screening was similar, and approximately -4.5 +/- 0.2 thousand US dollars per gained DALY. In the proposed cohort [10,000 neonates], gained DALYs were 316 +/- 50 for a cut off point of 5 mU/l, 251 +/- 40 for 10 mU/l, 146 _ 23 for 15 mU/l, and 113 +/- 18 for a cut-off point of 20 mU/l. Sensitivity analysis showed that the model remained the same when the input parameters were changed. This study demonstrates that the current threshold of TSH in the national CH screening program in terms of cost-effectiveness is the most appropriate threshold. However, more studies are needed to examine new strategies and methods to reduce recall rates and related consequences such as repeated thyroid testing in neonates

use of polymerase chain reaction assay versus cell culture in detecting neonatal chlamydial conjunctivitis

One of the most common bacterial infections that causes ophthalmia neonatorum is Chlamydia trachomatis, [C. trachomatis]. Very few studies have been performed in Iran using both cell culture and polymerase chain reaction [PCR] methods to determine the prevalence of C. trachomatis as an etiological agent of ophthalmia neonatorum. This study aimed to evaluate the prevalence of neonatal chlamydial conjunctivitis [NCC] as diagnosed by both methods in two hospitals in Tehran, Iran. From March 2008 to May 2009, out of 2253 neonates, 241 [10.7%] with clinical findings of conjunctivitis were included in this study. A total of241 conjunctival swabs were tested by cell culture [as the gold standard test], PCR, and Giemsa staining. Cell cultures were positive for C. trachomatis in 31 [12.9%] neonates, C. trachomatis was positive in 40 [16.6%] neonates by PCR and 18 [7.5%] by Giemsa staining. The sensitivity of PCR was 100%, whereas Giemsa staining sensitivity was 58.1%. High sensitivity [100%] and specificity [95.7%] of PCR as compared to culture makes it a proper diagnostic method for the detection of C. trachomatis

Surveillance of ventilator-associated pneumonia in a neonatal intensive care unit: characteristics, risk factors, and outcome

This study determined the incidence, characteristics, risk factors, and outcomes of ventilator-associated pneumonia [VAP] in newborns hospitalized in a Neonatal Intensive Care Unit [NICU] in Tehran, Iran. A prospective cohort study was carried out in the NICU of Mandieh Hospital over a period of one year, from December 2008 to November 2009, on all neonates mechanically ventilated for more than 48 hours. VAP was diagnosed in accordance with the CDC definition of nosocomial pneumonias for patients younger than 12 months. Risk factors relevant to the development of VAP were studied. Multiple logistic and Cox regression analysis were performed to determine independent predictors for VAP and survival rate, respectively. There were 81 neonates enrolled. VAP occurred in 14[17.3%], at rate of 11.6/1000 days on the ventilator. Gram negative bacteria were the predominant etiologic agents. The most common bacterial isolates from the endotracheal aspirate were E.coli [21.4%]. KIebsiella [21.4%], and Pseudomonas [14.1%]. The only VAP predictor was sputum [odds ratio [OR]=5.11, P=0.02]. Mortality rate for VAP was 2/14[14.3%]. Duration of mechanical ventilation [hazard ratio [HR] 0.96, P0.01], birth weight [HR=0.81, P < 0.001], and purulent tracheal aspirate [HR=0.25, P < 0.006] were independent predictors of overall survival. VAP occurs at a significant rate in mechanically ventilated newborns. Additional studies are needed to accurately determine the incidence and risk factors in order to develop effective preventive and therapeutic protocols

Immunohistochemical detection of p53 protein expression as a prognostic factor in wilms tumor

Histological typing, especially the evidence of anaplasia and stage of the tumor are two major prognostic indicators in Wilms tumor, but some genetic factors have recently been noted. Mutations in TP53, which is a tumor suppressor gene, have been demonstrated to be associated with poor prognosis in some malignancies. There are also few studies which have confirmed the correlation between p53 protein overexpression and advanced course in Wilms tumor. This study was conducted to determine the correlation p53 immunoexpression and prognosis and outcome of Wilms tumor. The overexpression of p53 in 44 specimens of children [26 boys and 18 girls] with Wilms tumor [median age, 36 months; range, 4 to 96 months] was assessed in Mofid Children's Hospital, Tehran, Iran. The overexpression of p53 was determined by immunohistochemistry with antihuman p53 antibody. A positive immunostaining for p53 was detected in 24 of the 44 cases [54.7%]. The grade of the tumor and anaplasia were associated with p53 positivity, but there was no association of p53 with the tumor stage. In comparison to p53 negatives, week-moderate and high p53-expressing tumors had significantly decreased the overall survival [hazard ratio, 3.75 and 8.61; P=.05 and P=.01, respectively]. Overexpression of p53 protein in Wilms tumor is an indicator of poor pro gnosis, because it is correlated with unfavorable histology tumors and a shorter survival period

Oral and dental health status in patients with primary antibody deficiencies

Primary antibody deficiencies [PAD] are a group of immune system disorders, associated with decreased levels of secretory and protective immunoglobulins. Because of the important role of immunoglobulins in the protection of oral cavity, patients with PADs are more susceptible to dental caries or oral manifestations. This study was performed to investigate the oral and dental manifestations of PADs patients. In this study, 33 patients with PADs [21 common variable immunodeficiency, 8 X-linked agammaglobulinemia and 4 hyper IgM syndrome] and 66 controls were examined; the number of decayed, missed and filled teeth [DMFT] were investigated. Aphthous was the most frequent manifestation in PADs patients [38.7%], which was significantly 16.7% higher than the controls [p=0.03]. The patients with PADs showed significantly higher presentation of other oral and dental manifestations, including herpes sores, candidiasis tonsillitis, gingivitis, calculus, enamel hypoplasia and other ulcerations. The mean DMFT scores were 6.15 +/- 3.6 and 1.93 +/- 0.4 in PADs patients and controls, respectively [p<0.001]. Although the patients with common variable immunodeficiency had higher means of DMFT in comparison with other groups of PADs, this difference was not statistically significant. This study showed significantly higher frequency of oral and dental manifestations in the patients with PADs compared to controls. Therefore, regular examination of oral cavity could be suggested in this group of immunodeficient patients

Association of serum soluble triggering receptor expressed on myeloid cells levels in malignant febrile neutropenic patients with bacteremia and fungemia

Infections are the major cause of morbidity and mortality in febrile neutropenic patients with malignancy. Rapid diagnostic tests are needed for prompt diagnosis and early treatment which is crucial for optimal management. We assessed the utility of soluble triggering receptor expressed on myeloid cells [sTREM-1] in the diagnosis of bacteremia and fungemia in febrile neutropenic patients. Sixty-five febrile neutropenic children with malignancy hospitalized in Mofid Children's Hospital during a period of one year from January 2007 were recruited for this cross sectional study [mean age 66.2 +/- 37 months; 35 females and 30 males]. Thirty patients [46.2%] had acute lymphoblastic leukemia, 2 [3.1%] acute myeloid leukemia, one [1.5%] lymphoma and 32 [49.2%] were under treatment for solid tumors. Simultaneous blood samples were collected for measurement of serum sTREM-1 levels and for blood cultures which were grown in BACTEC media. Gold standard for the presence of infection was a positive BACTEC culture as a more sensitive method compared to current blood culture techniques. Blood cultures with BACTEC system were positive in 13[20%] patients [12 bacterial and one fungal culture]. The mean serum sTREM-1 level in BACTEC positive patients was 948.2 +/- 592.9 pg/ml but in BACTEC negative cases it was 76.3 +/- 118.8 pg/ml [P<0.001]. The optimal cut-off point of sTREM-1 for detecting patients with positive result of BACTEC was 525 pg/ml with sensitivity and specificity of 84.6% and 100%, respectively. Our study revealed a significant association between serum sTREM-1 level and bacteremia and fungemia in febrile neutropenic patients suffering malignancy with acceptable sensitivity and specificity

Association between ABCB1-T1236C polymorphism and drug-resistant epilepsy in Iranian female patients

One third of epileptic patients are resistant to several anti-epileptic drugs [AED]. P-glycoprotein [P-gp] is an efflux transporter encoded by ATP-binding cassette subfamily B member 1 [ABCB1] gene that excludes drugs from the cells and plays a significant role in AEDs resistance. Over-expression of P-gp could be a result of polymorphisms in ABCB1 gene. We studied the association of T129C and T1236C single-nucleotide polymorphisms [SNP] of ABCB1 gene with drug-resistant epilepsy in Iranian epileptics. DNA samples were obtained from 200 healthy controls and 332 epileptic patients, of whom 200 were drug responsive and 132 drug resistant. The frequencies of the genotypes of the two SNP were determined by polymerase chain reaction followed by restriction fragment length polymorphism. No significant association was found between T129C and T1236C genotypes and drug-resistant epilepsy neither in adults nor in children. However, the risk of drug resistance was higher in female patients with 1236CC [P = 0.02] or CT [P = 0.008] genotype than in those with TT genotype. The risk of drug resistance was also higher in patients with symptomatic epilepsies with 1236CC [P = 0.02] or CT [P = 0.004] genotype than in those with TT genotype. The risk of drug resistance was lower in patients with idiopathic epilepsies with 129TT genotype [P = 0.001] than in those with CT genotype. Our results indicate that T1236C polymorphism is associated with drug resistance in Iranian female epileptic patients. Replication studies with large sample sizes are needed to confirm our results

Frequency of red cell alloimmunization in patients with beta-major thalassemia in an Iranian referral hospital

Frequency of red cell alloimmunization in patients with ?-major-thalassemia in Mofid children's hospital. Tehran. IranThis is a cross-sectional descriptive study conducted in Mofid children's hospital, March 2007. A total of 121 major thalassemia patients on regular blood transfusion were included in this study. Clinical and laboratory data were collected and analyzed to find out the frequency, pattern and factors influencing red cell immunization secondary to multiple blood transfusions in these patients. Mean age of patients was 13 [6.19] from 2-26 years. They had received regular blood transfusions during periods ranging from 1 to 25.5 years. Red cell alloimmunization was found in 9 patients [7.4%]. In female group, 5 out of 66 [7.6%] patients and in male group 4 out of 55 [7.3%] patients had evidence of alloimmunization.The mean age of patients with alloimmunization was 9.6 [6.5] years [range 3.7-20]. Four patients [44.4%] with alloimmunization were more than 3 years old at the time of first blood transfusion. The mean age at first blood transfusion in patients with alloimmunization and without alloimmunization was 2.8 [2.4] and 1.7 [2.0] years [P=0.1]. The differential rate of splenectomy as a risk factor between patients with and without alloimmunization [11.1% and 8% respectively] was not statistically significant [P=0.5]. Direct or indirect antiglobulin tests were positive in 5 [62.5%] patients. The blood alloantibodies by a panel of antibodies using standardized blood bank methods were detected in 4 patients, which were of anti-K and anti-D types. he rate of red blood cell alloimmunization is relatively low in our patients. The age at first blood transfusion and splenectomy were not statistically significant as risk factors for alloimmunization in this study