[ 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

Iranian oncologists' attitude towards fertility preservation in a sample group

Recent advances in cancer treatment have resulted in an increased number of cancer survivors. Fertility might be impaired by cancer itself or through gonadal damage as a consequence of radio-chemotherapy. Damages to reproductive organs are seen in minimally up to 30% of cancer patients. The aim of the present study was evaluate the attitude of Iranian oncologists toward fertility preservation. Thirty oncologists filled an author-designed questionnaire which included five multiple choice questions at Mahak hospital, Tehran in 2009. The data were collected and analyzed by SPSS 11.5 software. More than half of the oncologists believed that radio-chemotherapy has destructive effects on reproductive organs. This study showed that as high as 67% of the respondants believed fertility preservation should be offered to all patients at risk, but 40% of them insisted that the patients should bring up the topic themselves. Only 46% of the oncologist knew about fertility preservation techniques. The greatest barriers for accepting fertility preservation by the parents of children undergoing cancer treatment were: lack of information [41%], hopelessness from treatment prognosis [33%], fear of delay in starting the treatment [15%] and the priority of child survival [11%]. The specific challenges of counseling are time pressure between diagnosis and start of treatment, little knowledge about fertility preservation both by treating oncologists and parents; therefore a team consisting of oncologists, infertility specialists and social workers is recommended in these settings

[Is early sex reassignment in ambiguous genitalia reasonable?]

Ambiguous genitalia is a medical emergency in newborns and effort is made to perform sex reassignment and reconstructive surgery as soon as possible. However, conflict between the assigned sex and later gender identity are still present in many cases. This discrepancy between sexual and gender identities leads to several complications that are the focus of the present study. The literature review was performed by searching some knowledge-based databases such as Medline/PubMed [from the National Library of Medicine], Scopus, PsyClic and the Iranian Scientific Information Database [SID] on the internet and all the available articles in relevant journals published up to August 2009. A significant number of intersex individuals suffer from incoherence between the sex reassigned to them by the medical team, and their gender identity revealed to them in teen ages or adulthood. As an adult, a large number of these individuals do not live according to their early reassigned sex and some may seek further sex reassignment congruent to their gender identity. A number of these cases have spoken out against the treatments performed during their childhood. They believe that the current treatment strategies for intersex individuals are paternalistic and incompatible with codes of medical ethics and human rights. The current knowledge about the complexities of sexual identity development, gender identity, gender role and sexual orientation is sparse and incomprehensive. The current approach for the management of infants with ambiguous genitalia seems to need major reevaluation. It seems better to defer any sex reassignment and reconstructive surgery until their gender is revealed and they are legally eligible to decide about these issues by themselves

[Reliability of the Persian translation of the composite international diagnostic interview [CIDI] for diagnosing schizophrenia and bipolar disorder]

This study aimed to assess the reliability of the Persian version of the Composite International Diagnostic Interview [CIDI] for a lifetime diagnosis of schizophrenia and bipolar disorder according to DSM-IV and lCD-10. This project was conducted at three stages of translation of the instrument, reliability assessment and validation, and feasibility and diagnostic reliability assessments for bipolar disorder and schizophrenia using a test-retest methodology. Trained interviewers administered the instrument twice [at 3-7 days' interval] to 100 clients at four university centers [complete CIDI on 65 persons and psychosis/mania module on 35 persons]. Test-retest reliability of CIDI for bipolar disorder was moderate in DSM-IV diagnostic system and poor in ICD-10. Test-retest reliability of CIDI for schizophrenia was poor in both diagnostic systems. The results showed that the diagnostic reliability was good only for bipolar disorder in DSM-IV, otherwise it was not acceptable. However, since the samples were selected from the clinical population, the results cannot be generalized to the normal population. According to the results, adaptation of the key questions to the Persian culture must be considered