[ prevalence of the alpha-1 antitrypsin deficiency in patients with chronic obstructive pulmonary disease]

Alpha 1-antitrypsin deficiency [AATD] is one of the genetic risk factors in the patients suffering from chronic obstructive pulmonary disease [COPD]. The exact number of Iranians suffering from this disease is yet not known. Therefore, the aim of this study was to determine the prevalence of the deficiency of AAT enzyme in patients suffering from COPD. The topical test of AAT serum was conducted on 125 patients affected by COPD who had referred to Ekbatan Hospital of Hamadan in 2007. The diagnoses of COPD in these patients dad been confirmed through history and spirometerty test before and after bronchodilator inhalation and the outcomes had been confirmed based on GOLD regulations. In other words, after separation of serum from blood, the specific antibody of AAT was added to the sample. The AAT serum level was read according to nephelometry measurement and the results were given in g/L. The gathered data were then analyzed using SPSS software program and statistical tests such as T-test and chi[2] [p<0.05]. Out of 125 patients, 91 were male and 34 patients were female [2.7/1]. The mean age was 63 +/- 12 years and the mean AAT serum in the patients was between 0.710g/L and 2.696g/L [mean 1.311 +/- 0.364g/L]. Almost all of the male patients had history of smoking [91%] and this smoking and its dose [Pack/Year] were significantly related to the severity of COPD. There was no significant relation between plasma levels of AAT and smoking, age or sex. The average age of patients suffering from COPD in rational AAT deficiency was significantly lower. However, the severity of symptoms had no significant difference between patients with normal levels of AAT. Based on the findings of this study, no case of exact deficiency of AAT was found in patients suffering from COPD admitted to Ekbatan Hospital of Hamadan. Regarding geographical location and number of the samples, the possibility of prevalence of this disease in Hamadan is much lower than that of European countries. However, the relative deficiency of AAT [20% in this study] was higher than the amounts obtained from similar studies in European countries

[Comparison of adenosine deaminase serum level in COPD patients and healthy subjects]

Global initiative for Chronic Obstructive Pulmonary Disease [Gold] has defined COPD as a disease characterized by airflow limitation that is not fully reversible. COPD is a subset of obstructive lung diseases which also includes cystic fibrosis, bronchitis and asthma. Adenosine deaminase [ADA, E.C.3.5.4.4] converts adenosine to inosine. ADA has two isoenzymes; ADA1 and ADA2. In COPD patients the serum level of ADA increases which can be regarded as a result of reduction in ADA activity. In this study we evaluated the level of ADA and its isoenzymes in COPD patients and healthy subjects. This was a case control study. ADA activity in 30 COPD patients with age range of 20-60 years whose disease had been confirmed by a pulmonologist in Ekbatan Hospital, was compared to the activity of the same enzyme in 60 healthy subjects consisting of 30 non smoker and 30 smoker subjects as control groups. Data were introduced into SPSS version.13 software and analyzed by Kruskall-Wallis and two-way ANOVA tests. ADA activity in the COPD and smoker control groups was significantly lower than that of non smoker group [18.99 +/- 7 and 22.99 +/- 6.7 U/L, respectively]. Regarding ADA2 serum level, the difference between patient group and non smoker control group was significant [P<0.05]. Activity of ADA1 isoenzyme in the study groups did not show any significant differences. In general ADA activity was decreased in COPD patients. Decreased ADA activity together with increased adenosine level may play an important role in producing pulmonary damage in COPD patients

Thyroid tuberculosis presenting as a cystic nodule

Although tuberculosis involves every organ and has a wide range of clinical manifestation, however involvement of the thyroid gland is rare. We report a case of a 25-yr-old female with supraclavicular lymphadenitis that developed nodular swelling of the thyroid and had symptoms and sonographic features mimicking a nodule with a cystic component. The diagnosis was made by using fine needle aspiration [FNA]. We conclude that thyroid tuberculosis should be considered in the differential diagnosis of thyroid nodules and that FNA can be the main diagnostic procedure

Final test analysis of post graduate medical residents

Multiple choice questions are the most frequent test for medical students. It is important to analysis the overall response to individual questions in the test. The aim of this study is to analyse questions of post graduate medical residency tests. Final annual local [Hamadan medical school] and national tests given to three Residency groups including 17 Obstetrics and gynecology tests, 7 pediatrics and 12 internal medicine in 2004 were studied. In local tests residents answered to 148, 150 and 144 and in national tests to ISO MCQS. Questions were evaluated regarding cognitive domain level, Difficultly index and Discriminative index and finally to evaluate the optimal, proper acceptable and "must omitted" questions. Questions of local Obstetrics and gynecology, pediatrics and internal medicine tests evaluated the "recall" level in 72%, 72% and 51% and in national tests 71%, 35% and 19%, respectively. Questions with Discriminative indices of 0.7 of more [proper] were 3 and 5% in Obstetrics and gynecology 3.5% and 1% in pediatrics and 1% in local and national tests. Proper difficulty indices [30-70] were shown in 53% and 54% in Obstetrics and gynecology, 34% and 43% in pediatrics and 40% and 42% in internal medicine. Generally evaluating, "must omitted" questions in local and national test were 76% in Obstetrics and gynecology, 81% and 79% in pediatrics and 91% and 85% in internal medicine. The most common causes making the questions to be considered "must omitted" in internal test were negative, zero or less than 0.2 Discriminative indices. Test analysis of final annual local [Hamadan medical school] and national test of Obstetrics and gynecology, Pediatrics and internal medicine residency programs in 2004 revealed that most of the questions are planned in "recall" level, harbor improper Discriminative indices, Difficulty indices and generally evaluating are "must omitted"