[Reliability of fine needle aspiration cytology for salivary gland lesions]

Fine needle aspiration [FNA] cytology is a safe, reliable, minimally invasive and cost-effective technique for the diagnosis of salivary gland lesions. This study aimed to assess the accuracy, reliability and diagnostic value of FNA cytology in Iran. A total of 200 records of patients with a history of biopsy or surgical excision of salivary gland lesions along with their histological and cytological examination results were retrieved and evaluated in the Pathology Department of Amir Alam Hospital during 2007-2013. The results of cytological diagnosis were divided into 4 groups of unfavorable, benign, suspicious and malignant. The cytological results were compared with histological data. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of FNA cytology were calculated using SPSS version 16.00. Of the specimens chosen for the study, 173 were from the period, 22 from the submandibular and 5 from the minor salivary glands. FNA cytological diagnosis was benign in 161 cases, suspicious for malignancy in 4 cases, and malignancy in 35 cases. Of 161 cases diagnosed as benign by FNA cytology, 25 were malignant and the frequency of false positive results was 15.5%. The accuracy, sensitivity, specificity, positive and negative predictive values of the FNA test were 82, 53, 93, 72 and 84%, respectively. A good agreement exists between the FNA results and final histopathological diagnosis of salivary gland tumors. Also, this study showed that FNA cytology, 25 were malignant and the frequency of false positive results was 15.5%. The accuracy, sensitivity, specificity, positive and negative predictive values of the FNA test were 82, 53, 93, 72 and 84%, respectively. A good agreement exists between the FNA results and final histopathological diagnosis of salivary gland tumors. Also, this study showed that FNA cytology has moderate accuracy and relative diagnostic value for diagnosis of salivary gland lesions

Comparison of serum neutrophil gelatinase-associated lipocalin [NGAL] with serum creatinine in prediction of kidney recovery after renal transplantation

Because of some insult to kidney during transplantation, assessment of kidney function after the procedure is essential. It would be ideal to find a marker better than creatinine to early predict the acute kidney injury. To compare with creatinine the predictive value of serum neutrophil gelatinase-associated lipocalin [NGAL] in detecting kidney recovery after renal transplantation. We studied 33 patients who received kidney transplantation [deceased [n=20] and live [n=13]] during a 6-month period in 2010. Serum NGAL and creatinine, hemoglobin, and blood glucose were measured at 0,12, 24,48, and 72 hours after transplantation. The need for dialysis and kidney function in one week were studied. There were 16 men and 17 women with the meantSD age of 36.3 +/- 12.2 [range: 14-58] years. Of the studied patients, 6 had delayed graft function [DGF; hemodialysis within the first week of transplant]; 9 had slow graft function [SGF; serum creatinine reduction from transplantation to day 7 <70%], and 23 had immediate graft function [IGF; reduction in serum creatinine >70%]. At any time, serum NGAL, and creatinine levels were significantly higher among patients with DGF [p=0.024] and SGF [p=0.026] compared with those with IGF. However, in those who got IGF vs non-IGF, serum creatinine levels were not significantly different [p=0.59] but serum NGAL levels differed significantly[p=0.020]. Receiver-operating characteristic [ROC] curve and area under curves [AUCs] of serum NGAL and serum creatinine levels on the first post-transplantation day had similar significance in predicting the patient's need to dialysis in the first week. However, using AUC of serum creatinine was not helpful in predicting non-IGF, compared to serum NGAL. The AUCs of the serum NGAL were 0.70 [95% CI: 0.52-0.89] and 0.76 [95% CI: 0.59-0.93] after 12 and 24 hours, respectively [p<0.05]. The highest AUC [0.82] was attributed to serum NGAL of 24 hour [p=0.002]. Serum NGAL level especially 24 hours post-transplantation, seems to be an early accurate predictor of both the need to dialysis and slow graft function within the first week of kidney transplantation

Characteristics of patients with cystic fibrosis: experience in a large referral children's hospital in Tehran, Iran

Cystic fibrosis [CF] is an autosomal recessive disease caused by a CF trans-membrane regulator [CFTR] defect. Its prevalence is 1:2500 in Caucasians, 1:15300 among African Americans and is rare in Southeast Asia. The present study aims to review demographic data, clinical manifestations and laboratory findings of Iranian children diagnosed with CF who referred to a Children's Hospital Medical Center in Tehran, Iran during a ten-year period. In a retrospective study from 1991-2000, all hospitalized patients with documented CF were reviewed. Diagnosis was based on clinical findings and sweat chloride levels above 60 mEq/L. A total of 233 patients [females: 91 [39.1%], males: 142 [60.9%]] were enrolled. The onset of symptoms was before the first month of life in 12.1%, between 1-6 months of age in 75.1%, and between 6-12 months of age in 6.9% of patients. Consanguinity of parents was present in 42.5% of patients. Respiratory [81.5%] and gastrointestinal [73.4%] symptoms, in addition to growth retardation were the most common presentations Eighty-eight percent of patients weighted below the fifth percentile. Of the 207 chest radiographs performed, the most frequent finding was hyper-aeration associated with pneumonia. Among 138 patients in whom barium swallows were performed, 102 [74%] had gastroesophageal reflux. A total of 27 patients expired, mostly from respiratory failure [96.3%]. CF is not a rare disease in Iran. We suggest early diagnosis and appropriate maintenance therapy for improving morbidity and mortality amongst CF patients

Prevalence and molecular identification of mediterranean glucose-6-phosphate dehydrogenase deficiency in Khuzestan Province, Iran

Glucose-6-phosphate dehydrogenase [G6Pd] deficiency is the most frequent genetic enzymatic disorder in human, which is inherited as an X-linked gene. It encodes a housekeeping enzyme, which is vital for cell survival. According to previous investigations, Mediterranean mutation [C563T] of g6pd gene is the most prevalent mutation in some provinces of Iran and neighboring countries. We aimed to study the Mediterranean mutation of g6pd gene in Khuzestan province of Iran. A total of 1064 randomly selected male blood samples were selected in Ahvaz, Khuzestan Province, in 2008 and screened for G6PD deficiency using fluorescent spot test method. In order to determine the frequency of G6PD Mediterranean variant, 144 G6PD deficient samples were analyzed by PCR-RFLP method. Eighty-one out of 1064 random selected screened samples were G6PD deficient, so a 7.6% frequency was obtained for G6PD deficiency. In addition, 105 out of 144 collected deficient samples had Mediterranean mutation that resulted in a 72.91% allel frequency. Corresponding to other investigations in Middle East countries and some provinces of Iran, we found that the Mediterranean mutation of g6pd gene was the most prevalent variant and G6PD deficiency occurred in a high frequency

Primary central nervous system lymphoma

Primary central nervous system lymphoma [PCNSL] is an extremely rare condition in childhood. We report the first case of PCNSL in a child in Iran. A nine-year-old boy was referred to Mofid Hospital with the history of headache of four months and seizure of 2 months duration. Magnetic resonance imaging of the brain revealed a hyper-intense lesion in left fronto-parietal area with secondary satellite lesions. Biopsy of the brain mass was performed. Pathologic findings showed brain lymphoma and immunohistochemistry confirmed this diagnosis. The treatment started with intrathecal and systemic chemotherapy in combination with radiotherapy

Acute combined demyelination of CNS and PNS: a case report

Acute disseminated encephalomyelitis [ADEM] and Guillain-Barre syndrome [GBS] are both para infectious demyelinating disorders. While ADEM almost always affects the CNS, GBS affects the PNS. The combined demyelinating process - demyelination of both upper motor neuron [UMN] and lower motor neuron [LMN] - occurs very rarely. Here we report a case of severe combined peripheral and central demyelination, in which the former disorder was preceded by the latter

[Relationship between ADPKD and post renal transplant diabetes mellitus]

Autosomal-dominant polycystic kidney disease [ADPKD], a common hereditary disease, is characterized by the progressive development and enlargement of multiple cysts in both kidneys, and typically resulting in end stage renal disease [ESRD] by the fifth decade of life. Post-transplant diabetes mellitus [PTDM], a common complication after transplantation with an incidence rate of 2.5-20%, is associated with poor graft and patient survival. In few studies, PTDM has been more frequent in ADPKD transplanted patients. In the present study, we investigated whether there is any association between PTDM and ADPKD in our patients. In this prospective study, 140 non-diabetic and nonsmoker successfully transplanted patients [27 ADPKD and 113 non ADPKD patients] were enrolled during three years. Both groups were matched for age, sex, body mass index [BMI], duration of renal replacement therapy before transplantation and also immunosuppressive protocols after transplant. Post-transplant diabetes mellitus was defined as Clinical Practice Guidelines advocated by Canadian Diabetes Association. All patients were followed for 12 months. PTDM occurred in 11.1% of ADPKD patients and in 13.1% of control group which was statistically insignificant [P > 0.05]. The development of PTDM in ADPKD group was not related to sex, age, and hypertension, duration of renal replacement therapy before transplantation, BMI and serum creatinine levels [P > 0.05]. Post-transplant diabetes mellitus appears not to be associated with autosomal-dominant polycystic kidney disease as an etiology of end stage renal disease

Effect of oral garlic on arterial oxygen pressure in children with hepatopulmonary syndrome

To study the effect of oral garlic on arterial oxygen pressure in children with hepatopulmonary syndrome. Garlic powder in a capsule form was given to 15 children with hepatopulmonary syndrome [confirmed by contrast echocardiography] at the dosage of 1 g/1.73 m[2] per day. Patients were evaluated clinically and by arterial blood gas every four weeks. The garlic capsule was administered to 15 patients with hepatopulmonary syndrome. There were 10 boys and 5 girls with a mean age of 9.4 +/- 3.9 years. The underlying problems were biliary tract atresia [4 patients], autoimmune hepatitis [4 patients], cryptogenic cirrhosis [4 patients] and presinusoidal portal hypertension [3 patients]. Eight patients [53.3%] showed an increase of 10 mmHg in their mean arterial oxygen pressure. The baseline PaO2 was 65.6 +/- 12.1 mmHg in the responder group and 47.1 +/- 11.2 mmHg in non-responder group. At the end of treatment the mean PaO[2] in responders and non-responders was 92.2 +/- 7.75 mmHg and 47.5 +/- 11.87 mmHg, respectively [P < 0.01]. Garlic may increase oxygenation and improve dyspnea in children with hepatopulmonary syndrome