Celecoxib for the treatment of mild-to-moderate depression due to acute brucellosis: a double-blind, placebo-controlled, randomized trial.

WHAT IS KNOWN AND OBJECTIVE: Depression is a debilitating complication of brucellosis and how best to treat this is a matter of debate. Inflammatory processes are involved in the pathogenesis of both brucellosis and depression. Therefore, we hypothesized that celecoxib could be beneficial for the treatment of depression due to brucellosis. METHODS: Forty outpatients with depression due to brucellosis with a Hamilton Depression Rating Scale score (HDRS) <19 participated in a randomized, double-blind, placebo-controlled trial and underwent 8 weeks of treatment with either celecoxib (200 mg bid) or placebo as an adjunctive to antibiotic therapy. Patients were evaluated using HDRS at baseline and weeks 4 and 8. RESULT AND DISCUSSION: Repeated-measures analysis demonstrated significant effect for time × treatment interaction on the HDRS score [F (1·43, 57·41) = 37·22, P < 0·001]. Significantly greater response to treatment occurred in the celecoxib group than in the placebo group at the study end [10 patients (50%) vs. no patient (0%), respectively, P < 0·001]. No serious adverse event was observed. WHAT IS NEW AND CONCLUSION: Celecoxib is a safe and effective treatment for depression due to brucellosis when compared with placebo.

Application of peripheral blood Mycobacterium tuberculosis PCR for diagnosis of tuberculosis patients.

BACKGROUND: Mycobacterium tuberculosis (MTB) infection is a global health problem. Failure to accurately identify cases of active MTB has serious effects on both patients and the community. Acid-fast bacilli (AFB) smear has poor sensitivity and culture methods have a delay ranging from 1 to 8 weeks for diagnosis. Nucleic acid amplification assays may be suitable candidates for this purpose. PATIENTS AND METHODS: In a prospective study, we evaluated Mycobacterium tuberculosis DNA in peripheral blood samples with PCR technique in 190 patients with pulmonary and extra pulmonary tuberculosis whom were admitted to Tehran Imam Khomeini hospitals during 2006-2010. Three ml citrated blood samples were obtained from cases. DNA extraction was performed by QIAGEN commercial kit and PCR performed with IS1081 Primer. RESULTS: Fifty six cases had extra-pulmonary tuberculosis and 134 were pulmonary. Overall sensitivity and specificity of the PCR assay was 41.1% and 95.5%, respectively. CONCLUSIONS: MTB-PCR assay on PBMC using IS1081 primer has a low sensitivity and now can not use as a single or alternative diagnostic test for tuberculosis. However, with regard to its high specificity can use for help diagnosing of TB in cases have no enough sputum (or other specimens) to examination for acid-fast bacilli (AFB) smear and culture.

A simple well-logging tool using boron-lined sodium iodide scintillators and an 241Am-Be neutron source.

A couple of 2-inch by 2-inch right cylinder sodium iodide scintillators and an Am-Be radioisotope neutron source have been used in a neutron porosity well-logging tool to explore the variation of hydrogen contents in a prototype formation. Both Monte Carlo N-particle transport code simulation and experimental results of the near- to far-detector responses confirm the reliable sensitivity of proposed tool to the formation porosity.

Osteoarticular tuberculosis in Tehran, Iran: a 2-year study.

Osteoarticular tuberculosis (TB) accounts for 1-5% of all TB cases and 10-18% of those with extrapulmonary infection. Diagnosis is difficult, because the lungs are rarely involved and there are no specific signs or symptoms. The purpose of this study was to assess the frequency and clinical and laboratory findings in osteoarticular TB in two referral hospitals in Tehran, Iran. The hospital dataset of patients admitted with osteoarticular TB during 2003-2005 was reviewed. Patients' demographic data, clinical presentation and radiological and pathological findings were analysed. Weight loss (50%), fever (36%) and night sweats (38.5%) were the most common constitutional symptoms. Knee, ankle, hip and shoulder joints were the most frequent sites for TB arthritis. In osteomyelitis, long and short bones were equally affected. In TB spondylitis, the lumbar (22.7%) and thoracic (50%) vertebrae were the most commonly involved sites. The most frequently reported complications were sphincter disorder (39.1%), paraplegia (28.9%) and kyphosis (19.3%). TB osteomyelitis must always be borne in mind in countries where TB has high prevalence.

Clinical profile and management of brucellosis in Tehran - Iran.

BACKGROUND: Brucellosis is one of the most frequent infectious diseases in many regions of Iran. The purpose of this study was to evaluate different clinical, laboratory and therapeutic aspects of this disease. METHOD: This retrospective descriptive study was performed on patients referred to two teaching hospitals in Tehran/Iran with brucellosis diagnosis during the years 1998 - 2005. Patients' signs and symptoms, laboratory findings and clinical responses were evaluated during the study period. RESULTS: More than half of the 415 patients enrolled in this study were female. The duration of the symptoms was reported to be less than 2 months in 83.85% of the patients prior to being examined in our centre. While sweating and fever were the most common symptoms, peripheral arthritis, sacroiliitis and splenomegaly were the most frequently reported signs. Rifampin plus cotrimoxazole was the most common regimen administered in these cases (32%) and relapse was also more frequently seen in this group of patients (13.8%), whilst doxycycline and cotrimoxazole led to the least number of relapses (2.5%). CONCLUSIONS: Brucellosis is known to have various manifestations, so it should be considered as one of the differential diagnoses of any patient referred with different organs involvement accompanied with or without fever. Relapse is one of the complications reported even following an appropriate treatment.

Assessment of the factors involving in the development of hypothyroidism in HIV-infected patients: a case-control study.

OBJECTIVES: Increased prevalence of thyroid dysfunction has been reported in HIV-infected patients, and recent studies have shown hypothyroidism as the most common thyroid function abnormality in this population, especially after treatment with antiretroviral drugs (HAART). The aim of this study is to assess risk factors of hypothyroidism in HIV-infected patients in Iran. DESIGN: This case-control study was conducted among 15 hypothyroid (cases) and 70 euthyroid (control group) HIV-infected outpatients. Serum Free T4, Free T3, and TSH levels were measured, and data on age, sex, body mass index, opium addiction or injection of illicit drugs, duration of HIV infection and HAART, disease stage, CD4-cell count, opportunistic infection (OI) or malignancy, HCV co-infection, and drug use were collected. RESULTS: We found no association between hypothyroidism in HIV-infected patients and any parameters measured, and P value was not significant for receipt of HAART (0.141), CD4-cell count (0.094), duration of HIV infection (0.474), duration of HAART (0.418), HCV co-infection (0.146), OI (0.566), or receipt of rifampin (0.816). CONCLUSION: In this study, age, sex, HAART, mean CD4- cell count, duration of HIV infection, HCV co-infection, and OI were not significant risk factors of hypothyroidism in HIV-infected patients. The occurrence of hypothyroidism may be related to other factors or HIV infection itself. Therefore, hypothyroidism should be considered in all HIV-infected patients.

Evaluation of patient-related factors associated with causality, preventability, predictability and severity of hepatotoxicity during antituberculosis [correction of antituberclosis] treatment.

For evaluation the extent of antituberculosis drug-induced hepatotoxicity and also to determine the patient-related factors associated with causality, preventability, predictability and severity of hepatotoxicity induced by antituberculosis medications, a prospective study was conducted on 112 patients in a tertiary care university teaching hospital for three years. Causality, preventability, predictability and severity of hepatotoxicity were determined based on the available standard algorithms. Of 112 patients, 31 (27.7%) demonstrated hepatotoxicity. Two patients died from complications of liver-related illness. The mean duration of treatment before the onset of hepatotoxicity was 16.7+/-3.2 days. Malnutrition was present in 17 of 112 patients. Most of hepatotoxicity (25/31 or 80.6%) occurred within the first month of treatment. Reintroduction of antituberculosis drugs was possible in 29 of 31 patients. Univariate and multivariate analysis did not show significant relationships between the rate of hepatotoxicity with age, sex, nutrition and nationality. Our results showed that hepatotoxicity induced by antituberculosis drugs is a nonpreventable and unpredictable reaction. The causality of this reaction is classified as category A based on European grading of causality. This study noted that the frequency of hepatotoxicity induced by antituberculosis drugs in Iranian patients is higher than other studied populations.