An Assessment of Changes in the Magnesium Level During Gynecological Abdominal Surgeries

Background: Magnesium (Mg) is the fourth most common cation in the human body and the second most intracellular cation after potassium. It has a fundamental role in several vital functions. As this essential ion is not measured in routine chemistry panels, little is known about its alterations during intraoperative time.Aim: The present study was designed to determine the negative eff ects of postoperative hypomagnesemia during and after surgeries.Subject and Methods: This study was a descriptive interventional study involving 74 patients. All patients underwent gynecological abdominal surgeries, and anesthesia protocols were standardized to comprise general and spinal anesthesia. All the patients were aged between 25 and 45 years, with ASA class I and II. Their total serum Mg level was measured 1 h before and 2 h after the surgery. The total serum Mg, calcium, and albumin level were measured by photometric methods. Data were analyzed using SPSS version 16.0 (Chicago Illinois, (USA). Inferential statistic was done using Vilksonnon-parametric and Pearson’s correlation test. P<0.05 were considered as significant.Results: The mean serum Mg levels were 1.87 (0.32) mg/dl before and 1.55 (0.34) mg/dl after the surgeries (The normal range: = 1.7-2.5 mg/dl). Results illustrated a significant hypomagnesemia after operations. Conclusion: Clinical impact of hypomagnesemia during surgeries needs to be studied further. Moreover, surgeons should be warned about the severity of probable electrolyte imbalances induced by perioperative events to decrease associated morbidities. Keywords: ASA, cation, gynecologic surgeries, magnesium, magnesium level, photometric method, standardized anesthesia, surgerie

Evaluation of interleukin-2 to detect active and latent tuberculosis among household contacts of pulmonary tuberculosis cases

Background: The interferon-gamma release assays (IGRAs) are the most important diagnostic approach to Mycobacterium tuberculosis infection diagnosis. However, they cannot discriminate between latent tuberculosis infection (LTBI) and active tuberculosis (TB). Some recent studies suggested that interleukin-2 (IL-2) response to M. tuberculosis could be utilized as a potential biomarker to discriminate active disease from LTBI. Objectives: The current study aimed at evaluating the potential role of IL-2 to detect both active TB and LTBI among household contacts of patients with pulmonary TB in two TB-endemic regions of Iran. Methods: A total of 650 household contacts of patients with TB were invited to participate in the current study. All subjects were diagnosed on extensive clinical evaluation of active TB and LTBI based on clinical manifestations and laboratory findings. The IGRA test was performed using QuantiFERON®-TB Gold Plus. The serum level of IL-2 was measured using the ELISA Development Kit. Results: A total of 237 household contacts entered the final analysis, including 132 patients with LTBI and three with active TB. In addition, 14 subjects were included as TB controls and 102 as TB-uninfected controls. The serum level of IL-2 was significantly higher in active TB and LTBI patients than TB-uninfected controls. The ROC curve was plotted between active TB and LTBI, revealing that the cutoff point of 25.5 pg/mL identifies the active form with 88.24 sensitivity and 36.36 specificity. Conclusions: The current study indicated that the IL-2 assay could not discriminate between active TB and LTBI with acceptable sensitivity. © 2021, Author(s)

Clinical Definitions of Pertussis: Summary of a Global Pertussis Initiative Roundtable Meeting, February 2011

Existing clinical case definitions of pertussis are decades old and based largely on clinical presentation in infants and children, yet an increasing burden is borne by adolescents and adults who may manifest distinct signs/symptoms. Therefore, a “one-size-fits-all” clinical case definition is no longer appropriate. Seeking to improve pertussis diagnosis, the Global Pertussis Initiative (GPI) developed an algorithm that delineates the signs/symptoms of pertussis most common to 3 age groups: 0–3 months, 4 months to 9 years, and ≥10 years. These case definitions are based on clinical presentation alone, but do include recommendations on laboratory diagnostics. Until pertussis can be accurately diagnosed, its burden will remain underestimated, making the introduction of epidemiologically appropriate preventive strategies difficult. The proposed definitions are intended to be widely applicable and to encourage the expanded use of laboratory diagnostics. Determination of their utility and their sensitivity and/or specificity versus existing case definitions is required

Cervical ripening before surgical evacuation of first-trimester pregnancy: a comparison between misoprostol and trinitroglycerin

Introduction: Termination of pregnancy through curettage in the first trimester requires cervical ripening (CR) which can be induced by medicinal or mechanical methods. In the pharmaceutical method, vaginal administration of misoprostol, as well as vaginal trinitroglycerin (TNG), has been shown to induce effective CR. This study was conducted with the aim of comparing vaginal misoprostol and vaginal TNG in the CR of women candidates for the first-trimester curettage. Materials and Methods: This double-blind clinical trial study was conducted on 168 pregnant women with a gestational age of less than 14 weeks who were candidates for curettage. Participants were randomly divided into two groups receiving vaginally either TNG (400 µgr)(n=87) or misoprostol (400 µgr) (n=81). Then, the state of CR and the need for mechanical dilatation were compared between the two groups. Also, the presence of any side effects caused by drug use was determined. Results: The percentage of CR in the misoprostol group (67.9%) was significantly higher than in the TNG group (32.2%) (P0.001). Generally, the rate of complications in the TNG group (35.6%) was significantly higher compared with the misoprostol group (13.6%) (P>0.001). Conclusion: Vaginally Misoprostol is more effective than vaginally TNG on CR of first-trimester curettage as well as it significantly reduces the need for mechanical dilatation of the cervix

Diagnosis of latent tuberculosis infection among pediatric household contacts of Iranian tuberculosis cases using tuberculin skin test, IFN- γ release assay and IFN-γ-induced protein-10

Background: Although the World Health Organization has recommended the diagnosis and prophylactic treatment of latent tuberculous infection (LTBI) in child household contacts of tuberculosis (TB) cases, the national programs in high-burden TB regions rarely implement adequate screening of this high-risk group, mainly because of resource limitations. We aimed to evaluate the prevalence of LTBI among pediatric household contacts of TB cases in two high-burden provinces in Iran. Methods: We conducted a cohort study in children who had been in household contact with a TB index. All subjects were assessed for active TB disease. For LTBI diagnosis, tuberculin skin test (TST) and QuantiFERON®-TB Gold Plus (QFT-Plus) were performed at the time of the index TB case diagnosis, as well as, 3, 12, and 18 months, if the first results were negative. In addition, interferon-γ-induced protein-10(IP-10) concentrations were measured for all participants. Results: A total of 230 children were enrolled, who had contact with an index TB case. Three contacts were diagnosed with active TB. According to the TST/QFT-Plus results, 104 (45.2) children were identified with LTBI during our study. Significantly increased IP-10 levels were found in LTBI patients compared to healthy contacts. Accordingly, more than 50 of LTBI contacts and about 10 of healthy contacts were considered as IP-10-positive. Conclusion: This study alarmingly illustrates a high prevalence of LTBI among Iranian children exposed to TB cases. We, therefore, emphasize that the children living in close contact with an infectious TB case should be screened effectively and receive prophylactic therapy. © 2021, The Author(s)

Evaluation of Clarithromycin and Metronidazole Resistance of Helicobacter Pylori Infection in Symptomatic Iranian Children

Helicobacter Pylori (H. pylori) as a gram-negative bacterium is the most common infection of the gastrointestinal tract, and worldwide it affects the children over three years of age. H. pylori could cause gastrointestinal and extra-intestinal manifestations. Antibiotic resistance can happen primarily and occurs during treatment. We aimed to evaluate the resistance gene of H. pylori obtained from gastric biopsy by polymerase chain reaction (PCR) method in Iranian children over 3 years old. Materials and Methods This study was a cross-sectional to evaluate the resistance gene of H. pylori obtained from gastric biopsy by polymerase chain reaction method for metronidazole and clarithromycin in children over three years old referring to the Mofid Children's Medical Center in Tehran, Iran. Results: Finally, data from seventy-nine samples included (mean age=10.7 years and male gender = 60.8%). Beta Globulin (BG) gene were detectable in 75 (94.93%) specimens of 79 (100%). Seventeen out of 75 specimens showed positive results for molecular detection of H. pylori. The results of RFLP-PCR technique showed that mutation of RdxA gene in seven of 17 (41.1%) for Metronidazole resistance and one case of 17 (5.8%) mutation of 23Y RNA gene that leads to clarithromycin resistance. Conclusion: Regarding the results of our study, it is better to check microbial resistance by culture and antibiogram for the antibiotic regimen of the first and second line of H. pylori treatment in children

Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran

Background: Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq® (RV5)) in Iran, from the viewpoints of Iran's health system and society. Methods: The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3 was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results. Results: Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US 499.91 million. Also, US 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario. Conclusion: Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran. © 2014 Elsevier Ltd

Investigation of chromosomal abnormalities and microdeletion/ microduplication(s) in fifty Iranian patients with multiple congenital anomalies

Objective: Major birth defects are inborn structural or functional anomalies with long-term disability and adverse impacts on individuals, families, health-care systems, and societies. Approximately 20 of birth defects are due to chromosomal and genetic conditions. Inspired by the fact that neonatal deaths are caused by birth defects in about 20 and 10 of cases in Iran and worldwide respectively, we conducted the present study to unravel the role of chromosome abnormalities, including microdeletion/microduplication(s), in multiple congenital abnormalities in a number of Iranian patients. Materials and Methods: In this descriptive cross-sectional study, 50 sporadic patients with Multiple Congenital Anomalies (MCA) were selected. The techniques employed included conventional karyotyping, fluorescence in situ hybridization (FISH), multiplex ligation-dependent probe amplification (MLPA), and array comparative genomic hybridisation (array-CGH), according to the clinical diagnosis for each patient. Results: Chromosomal abnormalities and microdeletion/microduplication(s) were observed in eight out of fifty patients (16). The abnormalities proved to result from the imbalances in chromosomes 1, 3, 12, and 18 in four of the patients. However, the other four patients were diagnosed to suffer from the known microdeletions of 22q11.21, 16p13.3, 5q35.3, and 7q11.23. Conclusion: In the present study, we report a patient with 46,XY, der(18)12/46,XY, der(18), +mar8 dn presented with MCA associated with hypogammaglobulinemia. Given the patient�s seemingly rare and highly complex chromosomal abnormality and the lack of any concise mechanism presented in the literature to justify the case, we hereby propose a novel mechanism for the formation of both derivative and ring chromosome 18. In addition, we introduce a new 12q abnormality and a novel association of an Xp22.33 duplication with 1q43q44 deletion syndrome. The phenotype analysis of the patients with chromosome abnormality would be beneficial for further phenotype-genotype correlation studies. © 2019 Royan Institute (ACECR). All rights reserved