Evaluation of a Direct PCR in Comparison with Routine Microscopy and In Vitro Culture for Diagnosis of Cutaneous Leishmaniasis

Background: Cutaneous leishmainasis (CL) is highly prevalent in several provinces of Iran, having been increased during the recent decade. The diagnosis of CL in most of clinical laboratories is usually performed using routine microscopy. However, this method is not sensitive enough, and the assessment and utilization of other methods, including a variety of PCR techniques, have been taken to consideration. Methods: In the present study, a direct PCR, based on kDNA primers, in comparison with the microscopic examination and in vitro NNN culture was evaluated for the detection of CL. The scrapings were taken from 73 patients from Mirjaveh, Sistan va Baluchestan province, and subjected to the comparative diagnoses. Results: The results showed that 38.4%, 55.5% and 60% of the specimens were positive by microscopy, PCR and NNN culture, respectively. Separate comparisons of both microscopy and PCR methods with NNN culture, showed that the sensitivity of the PCR (76%) is higher than that of microscopy (61%). The calculated specificity, however, was 100% for microscopy and 73% for PCR. The parasite species were also characterized by PCR. Conclusion: In addition to the higher sensitivity, this particular PCR, which uses species-specific primers, has a major advantage of identification of Leishmania species at the same time. It is, therefore, concluded that this PCR technique can be a suitable complement to the routine microscopic examination for diagnosis and identification of the parasite species from suspected leishmaniasis

Survival rate of gastric and esophageal cancers in Ardabil province, North-West of Iran

BACKGROUND: Upper gastrointestinal cancer is the most common cancer in Ardabil Province, North-West of Iran, accounting for more than 50% of all cancer deaths in this area. We conducted this study to determine the present survival rate of patients with esophageal and gastric cancers before launching interventional studies. METHODS: A prospective follow-up study of 420 biopsy-proven patients (127 females, mean age: 64) with upper gastrointestinal cancer (141 esophageal and 279 stomach cancers) who were initially diagnosed in Aras Clinic, the main gastrointestinal referral center of Ardabil Province, from 2000 through 2004, was performed with collection of data on demographics, tumor characteristics, pathologic stage, treatment methods, complications, survival time, etc. Data were gathered through direct interview with patients or their families in 303 cases and evaluation of death certificates in 55 patients. Follow-up was from cancer diagnosis until death, or immigration. Survival according to stage of disease, Lauren tumor type, tumor location, surgery, and adjuvant chemotherapy was analyzed, and results were compared with those of western series. RESULTS: Sixty-two cases were lost to follow-up. The one- and five-year survival rates in the patients with upper gastrointestinal cancer in Ardabil Province were 40.5%, and 0.8%, respectively. In the univariate analysis, men had a slightly lower survival rate than women (P = 0.21) and patients with esophageal cancer had a longer survival rate compared to stomach cancer patients (P = 0.15). Patients who had undergone surgery (P < 0.001) and/or chemotherapy (P < 0.001) survived longer than those without such treatments. Tumor morphology, age at diagnosis, radiotherapy, alcohol, and opium consumption did not show any significant effects on the survival rate of patients. In multivariate analysis, only smoking was remained as an independent factor for stomach cancer (P = 0.04) while in esophageal cancer, surgery and grade of differentiation were significant predictors of survival. CONCLUSION: Survival rate of stomach and esophagus cancer cases in Ardabil is relatively low. Intervention for early detection and therapy is necessary to increase survival