Serum Procalcitonin level and other biological markers in children with bacterial or non-bacterial meningitis

Acute meningitis in children is predominantly aseptic and does not require specific treatment. However, meningitis has a bacterial origin in about 5% of patients and carries a risk of fatal outcome or severe neurological sequelae, especially when diagnosis and antibiotic administration are delayed. The objective of the present study was to evaluate the value of determining procalcitonin levels to discriminate between bacterial and non-bacterial meningitis in young children or infants and describe the variation in serum PCT levels over time during the treatment of meningitis.A total of 50 children with meningitis admitted to a University Hospital were followed in this prospective study. Cerebrospinal fluid (CSF) and serum levels of procalcitonin were measured. The diagnosis of meningitis was based on clinical findings, gram staining, culture, and chemical analysis of CSF. Twenty-five children were diagnosed as bacterial meningitis and the other 25 children as non-bacterial Meningitis.The mean procalcitonin level on admission in patients with acute bacterial meningitis was 18.3 ng/mL, and the lower level was 4.6 ng/mL, while the higher level in patients with non-bacterial meningitis was 0.62 ng/mL (mean level, 0.38 ng/mL). It  is  clear  from  the  range  of  serum procalcitonin level that, there are no overlapping values seen  for  serum  procalcitonin  in  both  groups.serum PCT levels can be used in the early diagnosis of acute bacterial meningitis and is more valuable than the other predictive marker. Similarly, they may be useful adjuncts in differential diagnosis of bacterial and non-bacterial meningitis and diminishing the value of 2nd lumbar puncture performed 48-72 hours after admission to assess treatment efficacy

A comparative study of Tacrolimus versus Cyclosporine as immunosuppression for kidney transplant recipients

Kidney transplantation is the most common transplantation in the world. Annually, a large number of patients that have chronic renal failure are undergoing renal transplantation and the major subject about these patients is the rejection of graft that should be controlled by immunosuppressive agents.  The aim of this study is investigation of the effect of Cyclosporin against Tacrolimus in patients with kidney transplantation. This study was performing between 2010 and 2012 on all patients who had kidney transplantation and refer to Imam Reza hospital from Kermanshah University of Medical Sciences. 100 patients, aged 18–60 years, with end-stage renal disease were administered either Tacrolimus (n=49) or Cyclosporine (n=51). In both groups, Cellept could be discontinued from day 92 onwards. Corticosteroid treatment comprised methylprednisolone boluses followed by a rapid prednisone taper from 20 mg (day 2) to 5 mg (day 43 and thereafter). Patients followed up 12 months. In the Tacrolimus treatment group, 7 grafts (14%) were lost and 8 (16%) grafts were lost in the Cyclosporine treatment group between months 0 and 12 and there is no significant different between these groups (P= 0.845). No cases were diagnosed with biopsy-proven chronic rejection at months 0 and 12. Mean serum creatinine concentrations were 1.8 ± 1.5 mg/dl in the Tacrolimus group and 2.3 ±2.9 in the Cyclosporine group by month 12 (P= 0.348). these data are consistent with previously published observations and confirm that Tacrolim us is a highly efficacious baseline immunosuppressant for patients undergoing kidney transplantation. Tacrolimus-based immunosuppression may promote long-term benefits with regard to graft functio n and graft survival

Clinical Features and Types of Von Willebrand Disease in Women with Menorrhagia Referred to Hematology Clinic of Kermanshah

Menorrhagia is the most common symptom that is experienced by women with bleeding disorders. Von Willebrand disease (VWD) is the most common congenital human bleeding disorder that is manifested as a quantitative deficiency in Von Willebrand factor (VWF) or dysfunction of this factor. The frequency of VWD is similar in both men and women. However, VWD is more readily detected in women due to the presence of severe bleeding associated with menstrual cycles and childbirth. The present study was carried out to find the frequency of VWD, its types, and clinical features of the disease among women with menorrhagia who referred to the Hematology Clinic of the Kermanshah University of Medical Sciences. The study comprised 482 women with menorrhagia. After excluding patients with confounding factors, 56 (11.6%) patients were evaluated for inherited bleeding disorders. We detected 31 (55.3%) patients with VWD. Type 3 of VWD was the most frequent subtype (45.1%) followed in frequency by type 2, (32.2%), and type 1 (22.5%). In conclusion, our study indicated that menorrhagia can be the first symptom of VWD. Therefore, rare coagulation disorders should be considered in women with idiopathic menorrhagia, particularly in regions with high rates of consanguinity

Frequency of Hereditary Coagulation Risk Factors in Deep Vein Thrombosis Patients Referred to Iranian Blood Transfusion Organization, Kermanshah

Introduction: The main inhibitors of coagulation pathway are antithrombin (AT), protein C and protein S. These inhibitors are necessary to prevent thromboembolism. Hereditary deficiency of inhibitors is the main cause of alteration in balance between the anti-clotting and the formation of thrombin. Patients with this abnormality are susceptible to venous thromboembolism (VTE). Two major clinical manifestation of VTE are deep vein thrombosis (DVT) and pulmonary embolism (PE). The aim of present study was to investigate the frequency of coagulation inhibitor proteins and resistance to activated protein C (APC-R) in DVT patients from Kermanshah province of Iran with Kurdish ethic background. Materials and methods: We investigated all patients with thrombophilia who referred to Iranian Blood Transfusion Organization from May 2011 to March 2012. The levels of protein C, protein S and antithrombin were measured using STAGO kits, France (Diagnostica Stago) and the APC-R level was detected using Pefakit® kit. Results: After excluding patients with confounding factors, 54 patients were remained. Our results showed that acquired risk factors are the most common causes of DVT in the present study. In our study protein C deficiency was found to be the most hereditary risk factor followed in frequency by APC-R. Also, in 16 patients (29.6%) there were combined hereditary risk factors with deficiency in 2 or 3 factors. Conclusion: Our results showed protein C deficiency was the prevalent cause of DVT in our patients. Also, different pattern of hereditary risk factors in our patients compared to other regions of Iran could be attributed to different ethnic background of our patients