Does inhibin-B help us to confidently refuse diagnostic testicular biopsy in azoospermia?

In the recent years, the use of laboratory blood factors such as FSH and inhibin-B for the assessment of spermatogenesis in different studies has increased; of course, the conflicting results have also been achieved. To investigate if the measurement of inhibin-B can help surgeon to reduce unnecessary diagnostic testicular biopsies in males with azoospermia. This cross-sectional study was done during July 2006 to September 2007 on 41 patients with azoospermia. FSH and inhibin-B were measured and bilateral open testicular biopsy was performed for all patients. Sperm was seen in 29% of biopsies that in 100% of these samples inhibin-B was more than 100 pg/mL and FSH was less than twice the normal [p=0.001]. Inhibin-B had significant correlation inversely with testicular fibrosis and Sertoli cell only syndrome [p=0.043 and p=0.011, respectively] and directly with incomplete spermatocytic maturation arrest and obstructive azoospermia [p=0.027 and p=0.013, respectively]. FSH was only correlated with obstructive azoospermia [p=0.001]. We suggest that if FSH is less than twice the normal, inhibin-B should be measured and if its level is less than 100 pg/mL, we can cancel about the half of unnecessary diagnostic testicular biopsies

Effect of dimenhydrinate on benign paroxysmal positional vertigo after Epley maneuver therapy

Benign Paroxysmal Positional Vertigo [BPPV] is the most common cause of peripheral vertigo in adults. Reason of this type of vertigo is movement of otoliths in semicircular canals [especially posterior]. Main treatments for BPPV are antivertiginous drugs and maneuvertherapy. The purpose of this study is to determine the efficacy of Dimenhydrinate after maneuvertherapy of Epley on duration, number of vertigo attacks and duration of dizziness after each vertigo attack in patients with Posterior canal BPPV. One hundred forty eight patients with posterior Canal BPPV were evaluated in a randomized clinical trial in 2008 2009.Maneuvertherapy of Epley were done for all patients. They were divided into two groups: Dimenhydrinate group [75] and Placebo group [73] and drug prescribed for 2 weeks. Patients were followed up after treatment for duration of vertigo [days], number of vertigo attacks and duration of dizziness after each vertigo attack [minute]. Data were analyzed with statistical software SPSS 11/5 and comparison of means were done with T test and relationship between qualitative variables with X[2] square. Mean duration of recovery from vertigo attacks were 3/2 +/- 2/9 days in Dimenhydrinate and 3/8 +/- 3/3 in Placebo groups, mean number of vertigo attacks after treatment were 2 +/- 0/7 in Dimenhydrinate and 2/2 +/- 1 in placebo groups and Mean duration of dizziness after each vertigo attack was 32/75 +/- 2/07 minutes in Dimenhydrinate and 39 +/- 3/55 minutes in placebo groups with no statistically difference [P<0/05]. Epley maneuvertherapy is an effective treatment for Posterior canal BPPV and adding Dimenhydrinate does not increase its effectiveness

[Determination of Rifampin and Isoniazid resistant mycobacterium tuberculosis in Kermanshah [2006-2008]]

Tuberculosis is one of the most important infectious diseases and a major cause of morbidity and mortality in developing countries. Multi drug resistant tuberculosis is a new threat, which can result in a high case fatality rate. This study was conducted to define the incidence of multidrug resistant tuberculosis in Kermanshah. Antibiogram was performed on PCR-confirmed isolates of mycobacterium tuberculosis by using the proportion method. Eight cases [57.1%] showed resistance to 1microg/ml Isoniazid. Resistance to Rifampicin was identified in 46.2% of cases. This study showed a high rate of single drug and multidrug resistance. We recommend antibiogram for all cases of tuberculosis

[ comparative study of eradication of H. pylori infection in dyspepsy patients using a low dose and a high dose triple therapy with clarithromycin, amoxicillin and Omeprazole]

Helicobacter Pylori is a major cause of diseases of the upper gastrointestinal tract. Having considered the high prevalence of the infection, an ideal regimen has been a matter of debate by the scientists for many years. This study evaluates the efficacy of the more tolerable regimens in the eradication of the bacteria and the effect of the treatment on the gastric symptoms. This parallel randomized control trial study included 560 patients with dyspepsia admitted to Imam Reza Hospital, Kermanshah University of Medical Sciences between 2006-2007. Patients who were identified with dyspepsia based on Rome II and were candidate for endoscopy were examined for H. pylori infection through rapid urease test and histology. Those proven positive were assigned at random to one of the two groups of high dose [Omeprazole 20mg, Clarithromycin 500 mg, and Amoxicillin 1000 mg] and low dose [Omeprazole 20 mg, Clarithoromycin 250 mg, Amoxicillin 500 mg] treatment regimens. They all went under treatment every 12 hours for a period of seven days. 4 weeks after the therapy, eradication success rate and gastric symptoms were evaluated using the same protocol. Side effects were recorded through a questionnaire. From the total of 560, 480 were proven positive for H. pylori [85.7%]. Eradication success rate was the same for the two groups [87.5%]. History of pyrosis before the treatment was statistically associated with eradication failure at the end of the treatment. Symptoms such as pyroisis were significantly reduced. General well being was also improved but the improvement was not statistically significant. Mild side effects were observed in 11% of high and 8% of low dose treatment regimens. However they were well tolerated and did not result in drug withdrawal. Eradiation success rate of one-week low dose treatment regimen was within the acceptable level. Eradication also reduced pyrosis episodes. Symptoms were improved even when the therapy did not result in eradication

[Methylation of the GSTP1 gene promoter in colorectal cancer]

Transcriptional silencing of tumor suppressor genes and tumor related genes like GSTP1 by methylation of promotor region CpG island is believed to be an important mechanism in tumorigenesis. The GSTP1 gene encodes the enzyme glutathione S-transferase Pi which defends the cells against oxidative damage and electrophilic carcinogens. To gain insight into the role of epigenetic silencing of GSTP1 in colorectal cancer, its methylation was investigated in the blood samples obtained from tumor tissues [n=37] and the adjacent normal tissues [n=29] of patients with colorectal cancer as well as the blood samples taken from control subjects [n=42] by PCR after using methylation - sensitive restriction endonuclease ACCI. Methylation of GSTP1 was detected in the blood samples of control and blood, adjacent normal tissue and tumor tissue groups at 9.52%, 10.81%, 17.24% and 62.1% in respectively. There was a significant association between mehtylation of the GSTP1 in tumor tissues and the risk of colorectal cancer compared to adjacent normal tissues [OR= 7.86; 95% CI= 2.316 - 26.633]. The difference between methylation of the GSTP1 in the blood samples of case and control group [OR= 1.121; 95% CI= [0.26 - 4.84] was not statistically significant. Our findings indicate that methylation of the GSTP1 promotor may be detected in the tumor tissues. This could serve as a molecular diagnosis tool in detection and treatment of colorectal cancer

Diagnostic value of serological tests [IgA, IgG, IgM] against A-60 antigen in tuberculosis

Tuberculosis [TB] is a common infectious disease worldwide especially in developing countries. Diagnosis of TB is difficult and often needs paraclinical studies. Measuring immunoglobulin's against A-60 antigen of TB microorganism has been reported as a useful technique. The aim of the present study was to evaluate the diagnostic value of serologic test [IgA, IgM, IgG] against A-60 antigen in tuberculosis. For this case-control study, 176 TB patients [124 patients with smear-positive pulmonary TB and 52 patients with extra pulmonary TB] and 283 healthy controls were enrolled. Then, all subjects were tested for IgM, IgA and IgG against A-60 antigen using ELISA technique. Sensitivities of IgM, IgG and IgA test were 15%, 25% and 40%, respectively while the following specificities were also reported 100%, 75% and 90%, respectively. Positive predictive values [PPV] were 100%, 57% and 72%, however, negative predictive values [NPV] were 65%, 72% and 70%, respectively. Combination of immunoglobilins results increased sensitivity, for which the most sensitivity was observed in combination of IgG and IgA results. Our results revealed the usefulness of serologic testing in TB diagnosis. Although its sensitivity is not high enough, combination of immunoglobulin results may improve the sensitivity