Comparison of oral prednisolone pulse therapy with intravenous methylprednisolone pulse therapy in severe alopecia areata

Objective: To compare the efficacy of oral prednisolone pulse therapy in comparison to the intravenous methylprednisolone pulse therapy in treatment of severe alopecia areata. Patients and methods: In this interventional study, all patients with alopecia areata having at least 30% involvement of scalp or more than 10 patches of alopecia in scalp and body, registered during 2006-2009 in dermatologic department of 5-Azar hospital, Gorgan, Northeast of Iran were included. Forty patients with severe alopecia areata were enrolled and divided into 2 groups. Group A was treated with 200 mg oral prednisolone in one dose, every week for 3 months and group B were treated with 500 mg intravenous methylprednisolone on 3 continuous days each month for 6 months. Results: Recovery rate after 1, 3, 6 and 12th months after treatment was significantly higher in group B compared to group A. Side effects included: acne (5 in group A and 7 in group B), heartburn (4 in group A and 5 in B), striae (4 in group A and 6 in group B) and were more seen in group B but it was not significant statistically. The recovery and rate was not significantly different between two sexes. Conclusion: In this study, 500 mg intravenous methylprednisolone in 3 continuous days each month for 6 months showed a better recovery rate in severe alopecia areata. Patients must be warned about the side effects and outcomes

Appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: A comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteria

Appropriateness of referrals for myocardial perfusion imaging (MPI) in developing countries has not been extensively studied. Our study was conducted to describe the ordering practices of physicians and appropriateness of MPI referrals in Iran. We prospectively applied 2005 and 2009 versions of the Appropriateness Use Criteria published by the American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC) to 291 consecutive patients (age 55.3 ± 10.3 years) who underwent SPECT-MPI. For this purpose, we convened a panel, consisting of two academic cardiologists, one academic clinician in internal medicine, and one academic clinician in nuclear medicine. The panelists were invited for a face-to-face meeting to judge appropriateness of SPECT-MPI and independently assign a specific indication (scenario), whenever possible, for each case in accordance with ACCF/ASNC appropriateness scenarios. Based on the 2005 ACCF/ASNC criteria, SPECT-MPI studies were judged appropriate for 211 (72.5%), uncertain for 36 (12.4%), inappropriate for 32 (11.0%), and unclassifiable for 12 (4.1%) referrals. The same figures based on the 2009 version were 219 (75.3%), 15 (5.2%), 49 (16.8%), and 8 (2.7%) patients, respectively. Overall agreement between the 2005 and 2009 versions was good (κ 0.63). Lack of chest pain and age below 60 years were significant indicators increasing the likelihood of inappropriate referrals by 2.9-3.4 fold. Absence of diabetes mellitus and hypertension, a normal lipid profile, lack of a past history of myocardial infarction or cardiovascular interventions (CABGs or PCI), as well as lack of application and exercise ECG stress test as the gate keeper (keeping abnormal ETT or inability of the patient to perform exercise as the appropriate indication for SPECT-MPI referral) were significant indicators, decreasing the odds of appropriate referrals. Generally a higher percentage of referrals with inappropriate indications had normal MPI. Our study provides an evidence for the fact that SPECT-MPI ordering practices in our developing community largely parallel the ACCF/ASNC recommendations. The implementation of appropriateness criteria is feasible in clinical settings and might provide an alternative to utilization management. © 2011 American Society of Nuclear Cardiology

Numerical comparison on the efficiency of conventional and hybrid buckling-restrained braces for seismic protection of short-to-mid-rise steel buildings

Buckling-restrained brace (BRB) is a specific kind of bracing system which has an acceptable energy dissipation behavior in a way that would not be buckled in compression forces. However, considerable residual deformations are noticed in strong ground motions as a result of the low post-yield stiffness of the BRBs. The seismic performance of a modern lateral load resisting system, which is called the hybrid BRB, and its conventional counterpart are assessed and compared in this paper. Multiple plates with different stress–strain behavior are used in the core of this new innovative system, and this is its difference with the existent BRBs. Nonlinear static and incremental dynamic analyses are carried out for three building frames with different structural heights, which use conventional and hybrid BRB systems. To carry out response history analyses, the FEMA P695 far-field earthquake record set was adopted in different hazard levels. The hybrid BRBs are shown to have superior seismic performance in comparison with the conventional systems based on the response modification factor and the damage measures including residual displacements and inter-story drift ratios

Ultrastructural and molecular characteristics of Setaria species based on sequence analysis of genomic and mitochondrial gene markers in cattle (Bos taurus) and buffaloes (Bubalus bubalis) from Iran

ΔΕΝ ΔΙΑΤΙΘΕΤΑΙ ΠΕΡΙΛΗΨΗThe aim of the present study was to investigate the ultrastructural characteristics and genetic diversity of Setaria parasites from cattle (n=696) and buffalo (n= 522) from Khuzestan province of Iran and to compare them with available data from other countries/regions by sequences analysis of the 12S Rdna and the mitochondrial cytochrome C oxidase subunit I (cox1) genes. Based on SEM (Scanning Electron Micrographs) and light microscopy, all the isolated worms were identified as Setaria labiatopapillosa. Our results showed that 12.3% of cattle were infected with Setaria spp., while no infection was found in buffaloes. The maximal prevalence was observed in cattle younger than one year old. The prevalence rate was not influenced by the season of the year or gender. Comparison of the obtained sequences from Setaria with sequences of Setaria spp. from GenBank confirmed that all samples belong to the species S. labiatopapillosa. The phylogenetic tree constructed using cox1 and 12S rDNA genes of several other filarial nematodes showed that the Khuzestan isolates share a common branch with S. labiatopapillosa from other regions. Intra-specific variation was observed in 12S rDNA but not in cox1. In conclusion, our results indicating that S. labiatopapillosa is the main species involved in the spread of setarial infection in south-west of Iran and the identified worms corresponded mostly to worms that reported previously throughout other continents

QuantiFERON-TB gold and tuberculin skin test for the diagnosis of latent tuberculosis infection in children

Background: Appropriate diagnosis and treatment of latent tuberculosis infection (LTBI) play the most important role in the control of tuberculosis. This study aimed to determine theprevalence of LTBI among healthy tuberculosis unexposed children vaccinated with BCG using the tuberculin skin test (TST) and QuantiFERON TB Gold In-Tube (QFT-GIT) and comparing the agreement between the two tests. Methods: A cross-sectional study was carried out between October 2009 and March 2010 in 24 schools and 11 daycare centers. A total of 967 children were divided into 15 age groups, with a minimum of 64 children per group. Results: The prevalence rates of LTBI with TST were 3.8, and 2.2 with QFT-GIT. One case was positive in TST and QFT-GIT, 20 cases were QFT-GIT positive, but TST negative and 36 cases were TST positive, but QFT-GIT negative, and finally, 910 cas eswere negative in both. There was poor agreement between TST and QFT-GIT (1.8, 95, CI: 0-5.3, k=0.007). The specificity of QFT-GIT in the BCG vaccinate, children aged 1-15 years old, was 97.8 (97.8, 95 CI: 96.8-98.8). After three months, 2/17 (11.8) of those initially QFT-GIT negative converted, and 10/15 (66) of those initially QFT-GITpositive reverted. Conclusion: It seems that TST and QFT-GIT are not appropriate tests for the diagnosis of LTBI among healthy tuberculosis unexposed BCG vaccinated children. There was a low reproducibility rate of QFT-GIT. The cause of the the poor agreement requires further studies. © 2015 Shiraz University of Medical Sciences. All rights reserved

Prevalence and new histopathological aspects of Haemoproteus spp. in pigeons from Iran

ΔΕΝ ΔΙΑΤΙΘΕΤΑΙ ΠΕΡΙΛΗΨΗHaemoproteus spp. is pathogenic protozoan that effecting blood circulatory system of birds. The present study was undertaken to evaluate the presence of Haemoproteus spp. in pigeons from Iran and associatedhistopathological changes. A total of 108 blood samples were taken from pigeons to investigate Haemoproteus spp. presence by blood smear and semi-nested PCR targeting the cytochrome b gene methods. Also, to evaluate histopathological changes 12 infected pigeons to Haemoproteus were sacrificed and studied. 34.2% of pigeons infected with Haemoproteus showed macro and microgametocytes in their erythrocytes while based on the molecular method 63.8% were infected. Focal lymphocytic aggregates, pigmentation and cell swelling were the main histopathological lesions in infected livers. Multifocal non- suppurative interstitial nephritis, pigmentation and splenic lymphoid hyperplasia were also seen in the infected pigeons. Mild lymphocytic myocarditis in the heart of one pigeon was the other finding. No histopathological changes were seen in brain, intestine, and pancreas. Schizonts with variable shapes and sizes were detected in infected livers, lungs, kidneys, and spleens but megaloschizonts were not found. This study also reports the molecular prevalence of Haemoproteus spp. in Ira

Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in healthcare workers at Namazi Hospital, Shiraz, Iran

SummaryObjectiveThe aim of this study was to determine the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers (HCWs) at Namazi Hospital, Shiraz, Iran.MethodsThis cross-sectional study was conducted from July to November 2006. Nasal swabs were taken from 600 randomly selected HCWs. The isolates were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test, and mannitol salt agar fermentation. To analyze sensitivity patterns of MRSA strains more precisely, minimum inhibitory concentrations (MICs) of antibiotics were determined by the E-test method. All methicillin-resistant isolates were examined for the existence of the mecA gene by total DNA extraction and PCR.ResultsThe prevalence of nasal carriage of methicillin-sensitive S. aureus (MSSA) was 25.7% and of MRSA was 5.3%, with the highest nasal carriage of MRSA in surgical wards and the emergency department. There was no significant difference between the sexes (p=0.247), age (p=0.817), and years of healthcare service (p=0.15) with regard to the nasal carriage of MRSA and MSSA. In the univariate analysis, a statistically significant difference was only found for occupation (p=0.032) between the carriage of MSSA and MRSA. In the multivariate analysis, the occupation ‘nurse’ was independently associated with MRSA carriage (p=0.012, odds ratio 3.6, 95% confidence interval 1.3–9.7). The highest resistance rate for both gentamicin and clindamycin (69%) was noted among the MRSA strains. None of the MRSA strains were resistant to mupirocin, linezolid, fusidic acid, or vancomycin. The existence of the mecA gene in all 32 methicillin-resistant isolates was observed by PCR.ConclusionsThis study revealed the prevalence of nasal carriage of S. aureus strains among HCWs to be lower than that found in other studies from Iran. The antibiotic susceptibility patterns also differed, perhaps as a result of the excessive use of antibiotics at our hospital. Only the occupation of nurse was an independent risk factor for MRSA carriage