impact of treatment on serum level of procalcitonin in patients with active pulmonary tuberculosis

Introduction: About one third of the world's population is infected with tuberculosis [TB] and each year, about 1.5 to 2 million people die from TB. Procalcitonin [PCT] is an inflammatory marker that its level has variable results. There are some discussions in the utilization of PCT as a diagnostic marker in active pulmonary TB. The aim of this study was to compare serum PCT before and after treatment in patients with pulmonary TB

Materials and Methods: This study was conducted on patients with pulmonary TB. Data were collected using a check list. The serum level of PCT was measured by ELISA test at the beginning and after six months of treatment. All data were analyzed using SPSS 16

Results: Forty-two patients with active pulmonary TB entered in this study. The mean age of the patients was 45.48 +/- 12.54 years and 54.8% of them were male. Most of the patients [59.5 %] were rural inhabitants. There was a family history of TB in 26% of patients. The most common symptom [45.2%] was cough. Mean PCT prior to treatment was 1.25 +/- 0.98 ng/ml. and 81% of the patients had PCT higher than 0.5 to 5. After treatment PCT level reduced significantly [P<0.001]. The mean erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP] before treatment were 45.88 +/- 21.87 and 7.16 +/- 3.98 respectively that were reduced significantly after treatment [P<0.001]. Neutrophil counts before treatment was 6221 +/- 3161 Cells per ml. and decreased statistically significant after treatment [P=0.01]

Conclusion: Our results showed that the PCT levels in pulmonary TB were high in active disease and reduced after treatment. PCT level may be used for follow-up as a discriminative marker between active and cured pulmonary TB and predict treatment response, although the PCT assay cannot be substituted for microbiological and pathological data

PFAPA and 12 common MEFV gene mutations our clinical experience

Marshall Syndrome or PFAPA is an inflammatory periodic disease characterized by periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis. Although PFAPA is an auto inflammatory disease, it doesn't have genetic basis such as other periodic fevers. This study evaluates the 12 common MEFV gene mutations in patients with PFAPA syndrome. 21 patients with PFAPA syndrome who had diagnostic criteria were enrolled in this study and 12 common MEFV gene mutations i.e. P369S, F479L, M680I [G/C], M680I [G/A], I692del, M694V, M694I, K695R, V726A, A744S, R761H, E148Q evaluated. All the patients were screened for MEFV gene mutations by a reverse hybridization assay [FMF Strip Assay, Vienna lab, Vienna, Austria] according to the instructions provided by the manufacturer. The age of patients was between 6 months to 14 years, and 15 were males. Seven patients had heterozygote and one had compound heterozygote [K695R, V725A] mutation. There were 4 alleles M694V, 3 alleles V726A, 1 allele E148Q and 1 allele K694R. No significant difference existed between mutated patients with non-mutated in symptoms like aphthous and stomatitis, duration of attacks, episodes of fever and response to treatment. Gaslini score test was not helpful to predict the probability of gene mutations. About 30 percent of patients had MEFV gene mutations but these mutations did not play a main role in presentation of PFAPA symptoms

Predisposing factors of brain abscess in Ardabil

Brain abscess is a focal intracerebral infection, which begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized capsule. In the present study, we studied all patients with brain abscess admitted in Ardabil Fatemi hospital. In a retrospective hospital-based study, 24 patients with brain abscess entered the study. Medical records of patients were reviewed from January 2004 to January 2006. Brain abscess was defined as one or more localized lesions with the following characteristics in brain imaging [CT scan]: hypodense center with a peripheral uniform ring enhancement following the injection of contrast material, or affected region surrounded by variable hypodense area of brain edema or nodular enhancement or area of low attenuation without enhancement. Predisposing factors for brain abscess were surveyed by reviewing medical records. The study population included 17 males and 7 females with the mean age [ +/- standard deviation] of 27.0 +/- 21.3 years. The following predisposing factors were noted in 22 [[91.6%] patients; contiguous focus of infection [sinusitis and chronic otitis media] in 10 [41.6%], congenital heart disease in 5 [20.8%], post traumatic complications in 3 [12.5%], super infected hydatid cyst in 2 [8.3%] and neurosurgical complications in 2 cases [8.3%]. Ear in cerebellar and temporal lobe, frontal sinus in frontal lobe and heart in parietal lobe abscesses should be evaluated for the possible source of infection. Meanwhile, hydatid cyst may be an important risk for brain abscess in endemic areas like Ardabil