Quantitative and qualitative characteristics of Persian oak along altitudinal gradation and gradient (case study: Ilam province, Iran)

Quantitative and qualitative characteristics of Persian oak (Quercus persica) were studied in relation to altitude and slope variations in Ilam province. A total area of 1,500 m2 (30 × 50 m) was covered in five altitudinal classes ranging from 800 to 1,800 m a.s.l. Samples were taken based on a systematic random sampling method with 24 sample plots at each class. In total, 120 sample plots (in five classes) were collected covering four gradient categories ranging from 60%. An analysis of variance (ANOVA) was carried out to compare differences between group means in gradient categories and Duncan’s post-hoc test was performed to reveal differences between the means of various quantitative characteristics (e.g. growing stock, basal area, diameter at breast height, tree height and regeneration) and the altitudinal classes. The Kruskal-Wallis test was used to examine the differences between the means of qualitative variables and different altitudes and slopes categories. The results indicated that variations with altitudes may have a higher impact than slopes on the quantitative characteristics of the oak stands in the region while the qualitative variables of the native species were influenced by both altitudes and slope variations

CT-measured pulmonary artery diameter as an independent predictor of pulmonary hypertension in cystic fibrosis

Purpose: The role of computed tomography (CT) scan, as a promising prognostic imaging modality in cystic fibrosis(CF), has been widely investigated, focusing on parenchymal abnormalities. The aim of the present study was to evaluate the diagnostic performance of thoracic vascular parameters on CT to detect pulmonary hypertension (PH). Material and methods: CF patients who contemporaneously underwent CT and echocardiography were retrospectively enrolled. Baseline characteristics in addition to pulmonary artery diameter (PAD) and pulmonary to aortic (PA/A) ratio were compared between cohorts with and without PH, based on the results of echocardiography separately in paediatric patients (< 18) and adults (≥ 18). Results: Of a total 119 CF patients, 39 (32.8%) had PH (paediatric: 23/78, 29.5%, adult: 16/41, 39%). In paediatric CF patients, mean age, HCo3, PCo2, and pulmonary artery diameter (PAD) were significantly higher in the PH group compared to the non-PH group. Mean pulmo however, only PAD remained as the independent predictor of PH based on multivariate analysis (overall: 22.86 mm [±3.86] vs. 18.43 mm [±4.72], p = 0.005, paediatric patients: 22.63 mm [±4.4] vs. 17.10 mm [±4.64], p = 0.03). Using a cut off of 19.25 mm, the diagnostic performance of PAD to detect PH was found to be as follows: sensitivity = 82%, specificity = 70%, and accuracy = 73.1%. No significant difference was demonstrated in PAD between PH and non-PH groups in adults with CF (23.19 [±3.60] vs. 21.34 [±3.49], p = 0.7). Conclusions: In CF patients, PAD revealed an age-dependent performance to detect PH. PAD can be applied to predict pulmonary hypertension in paediatric CF patients and may be recommended to be routinely measured on follow-up chest CT scan in childhood CF

Breast Incidental Lesions at 18 F FDG PET/CT: Diagnostic Performance of PET-derived Metabolic Parameters

Background: Breast incidental lesion at 18 F FDG PET/CT are occasionally encountered in cancer patients, which may represent a second primary malignancy. The aim of the present study was to investigate the diagnostic performance of PET metabolic parameters to characterize breast incidentaloma.Materials and Methods: All the images of patients with cancers other than breast with breast incidental lesion underwent PET/CT scan at Masih Daneshvari Hospital between May 2012 and May 2016 were retrieved and reviewed. SUVmax, SUVmean, MTV and TLG in addition to associated morphologic features on CT and demographics were recorded and correlated with final diagnosis defined by histophatologic confirmation or an at least 1-year clinical formal follow up.Results: Of a total 58 from 51 patients (51/5029, 1.01%), 10 (19.60%) were histopathologically verified as second primary breast cancers. There was a statistically significant difference in SUVmax, SUVmean, MTV and TLG between benign and malignant group (1.64 vs. 5.32 (p=0.009), 1.34 vs. 3.69 (p=0.027), 0.96 vs. 2.62 (p=0.035), 1.54 vs 8.89 (p=0.006). Using cut off 2, 1.35, 1.16 and 1.75, sensitivity and specificity of SUVmax, SUVmean, MTV and TLG were calculated as 77% and 62%, 92% and 66.5%, 77% and 75% 77% and 67%, respectively.Conclusion: Despite a significantly higher value in malignant breast incidental lesion, PET-derivative metabolic parameters provided only modest sensitivity and specificity and hence may not be considered as the sole criteria for risk stratification in this clinical setting

Diagnostic Performance of F-18 FDG PET/CT in Patients with Cancer of Unknown Primary: Additional Benefit over CT-Based Conventional Work up

Background: In the era of well-developed site-specific treatment strategies in cancer, identification of occult primary is of paramount importance in CUP patients. Furthermore, exact determination of the extent of the disease may help in optimizing treatment planning. The aim of the present study was to investigate additional value of F-18 FDG PET/CT in patients with cancer of unknown primary (CUP) as an appropriate imaging tool in early phase of initial standard work up.Materials and Methods: Sixty-two newly diagnosed CUP patients with inconclusive diagnostic CT scan of chest, abdomen and pelvis referring for F-18 FDG PET/CT were enrolled in this study. Standard of reference was defined as histopathology, other diagnostic procedures and a 3-month formal clinical follow up. The results of PET/CT were categorized as suggestion for primary site and additional metastasis and classified as true positive, false positive, false negative and true negative. The impact of additional metastasis revealed by F-18 FDG PET/CT on treatment planning and the time contribution of F-18 FDG PET/CT in diagnostic pathway was investigated.Results: Sixty-two patients with mean age of 62 (30 men, 32 women), PET/CT correctly identified primary origin in 32% with false positive rate of 14.8%. No primary lesion was detected after negative PET/CT according to standard of reference. Sensitivity, Specificity and accuracy were 100%, 78% and 85%, respectively. Additional metastatic site was found in 56% with 22% impact on treatment planning. Time contribution for PET/CT was 10% of total diagnostic pathway.Conclusion: Providing higher detection rate of primary origin with excellent diagnostic performance, shortening the diagnostic pathway and improving treatment planning, F-18 FDG PET/CT may play a major role in diagnostic work up of CUP patients and may be recommended as an alternative imaging tool in early phase of investigation

Disseminated Bacille Calmette-Guérin infection at a glance: a mini review of the literature

Introduction: Immunodeficient children are at a high risk of disseminated Bacillus Calmette-Guérin [BCG] infection. We assessed the literature on clinical manifestations of BCGosis in children with specific primary immunodeficiencies. Material and methods: We conducted a systematic review of clinical practice articles by searching Medline, PubMed, Embase, Scopus, Web of Science and Google Scholar from their inception to date. Results: Thirty-seven articles were included regarding BCG vaccination and its dissemination in children with primary immunodeficiencies. Articles on dissemination after intravesicular BCG were excluded from the study. Conclusions: Since disseminated BCG vaccination may be the first manifestation of a primary immunodeficiency disease, a comprehensive search for immunological defects in children developing these problems after BCG vaccination seems rational

Brain-Included 18F FDG PET/CT Acquisition Protocol: Cancer-Specified Clinical Impact of Newly-Diagnosed Brain Metastasis in Extra-Cerebral Cancer Patients

Background: Evolution of individualized radiosurgical therapeutic methods for brain metastasis as an ominous prognostic finding may encourage a more extensive application of neuroimaging in patients with extracerebral cancer. The aim of the present study was to investigate the added value of brain-included 18 F FDG PET/CT acquisition protocol based on primary cancer type and clinical indication.Materials and Methods: A retrospective review was performed on 3945 18 F FDG PET/CT reports of patients with extra-cerebral cancer underwent brain-included PET/CT study. Cerebral lesions suggestive of brain metastasis were subsequently verified by MRI, MRI+MRS, surgical pathology and a 1-year clinical formal follow up. The detection rate of new brain metastasis and related impact on disease status were then investigated in each cancer type based on clinical indication.Results: Of a total 3933 eligible patients, 44 (1.12%) were finally verified to have new cerebral metastasis. The most common primary sources were lung cancer (19/385, 4.93%), cancer of unknown primary (CUP) (5/168, 2.97%) and breast cancer (8/468, 1.71%). The most common clinical indications were initial staging (17/44, 43.1%) and restaging (19/44, 36.4%). Change in disease status occurred in 12 out of 44 patients (27.3%), more frequently occurred in lung cancer (n=4), in all indications and breast (n=3) cancers at restaging (n=7, 43.8%).Conclusion: PET/CT acquisition protocol study may be best optimized based on the type of primary cancer and timing of evaluation. Brain-included field of view may be recommended for lung cancer regardless the clinical indication, cancer of unknown primary and breast cancer at restaging

Long term outcome of cystic fibrosis patients with multisystem evaluation

  INTRODUCTION: Cystic fibrosis is a chronic disease with multiple organ involvement and chiefly results in chronic respiratory infections, pancreatic insufficiency and associated complications. The age at diagnosis, clinical presentation, rate of disease progression and prognosis is variable among patients. This study is designed to evaluate the behavior of disease to provide epidemiologic data for early recognition and proper management. MATERIAL AND METHODS: The study was designed as an active surveillance of 192 patients diagnosed with cystic fibrosis in a tertiary lung disease centre between 2008 and 2015. The diagnosis of cystic fibrosis was established in all patients accordingly to conventional criteria, including two positive sweat chloride tests and clinical signs and symptoms. Demographic, clinical and laboratory data were obtained from these patients in each hospitalization and also every follow-up visit and carefully evaluated for complications of this chronic disease. RESULTS: The majority of patients showed positive culture for Pseudomonas aeroginosa. Bronchiectasis was the most prevalent finding in chest CT scan. 44.3% of patients had been treated for allergic bronchopulmonary aspergillosis and all had sinus disease. Increased pulmonary artery pressure was observed in 40% of patients with cystic fibrosis. 33 patients died which consisted 17.1% of all the patients.The mean age of mortaliy was 18.15 year. CONCLUSIONS: The clinical outcome of cystic fibrosis is variable in different countries which may reflect environmental influences and the role of early diagnosis on long term outcomes. However, the role of early diagnosis in long-term outcomes of the disease can not be ignored.

FEATURES OF ADOLESCENTS TUBERCULOSIS AT A REFERRAL TB'S HOSPITAL IN TEHRAN, IRAN

Abstract OBJECTIVE: To identify the pattern of the clinical, radiological, diagnostic procedures and loss to follow -up of the diagnosed cases of active tuberculosis (TB) adolescents. METHODS: This study was a retrospective analysis of the medical records of 143 adolescents aged 10 to 18 years with tuberculosis who were admitted TB wards of National Research Institute of Tuberculosis and Lung Disease (NRITLD) in Tehran, Iran, between March 2006 and March2011. RESULTS: Of the 143 patients identified, 62.9% were females. Median age of the patients was 16 years. The contact source was identified in 47.5%.The most common presenting symptom was cough (86%).Isolated pulmonary TB (PTB) was detected in 113 patients (79%), 21 patients (14.7%) had extrapulmonary TB(EPTB), and 9 patients (6.3%) had PTB and EP TB .The most common site of  EPTB was pleural (14%) .The most common radiographic finding was infiltration (61%).Positive acid fast smears were seen in 67.8%.Positive cultures for Mycobacterium tuberculosis(M. TB) were seen in 31.6%. Positive PCR results were seen in 60%.The adolescents aged 15 to 18 years were more likely to lose weight (p=0.001), smear positive (p=0.002)and have positive PCR results (p=0.009). The type of TB (p=0.017) was a significant factor influencing loss to follow-up. CONCLUSIONS: Adolescents with the high rate of positive sputum smear results and the high treatment default rate are more likely to increase risk for TB transmission to the community. The TB control programs should pay more attention to prevention and treatment of TB in adolescents.     Key words: adolescents, tuberculosis, Lost to follow-up, preventio

Effect of Active and Passive Exposure to Cigarette Smoke on Lipid Profile of Children and Adolescents; A Systematic Review and Meta-Analysis

Background: The present systematic review and meta-analysis is designed in order to assess the association between passive and active smoking and lipid profile of children and adolescents. Materials and Methods:  An extensive search was done in databases of Medline, EMBASE, Web of Science, Scopus and CINAHL until October 2017. Two independent researchers screened articles and in the next step, full texts of probably relevant articles were read and summarized. At the end, results of mentioned studies were pooled and a standardized mean difference (SMD) with 95% confidence interval (95% CI) was reported. Results: Data from 17 studies (containing 41619 children and adolescents; age group between 4 and 18 years old; 51.72% boys) were entered. Comparing serum level of high density lipoprotein (HDL) in two groups of exposed and non-exposed to cigarette smoking showed that active exposure (SMD= -0.40, 95% CI: -0.59 to -0.21) and passive exposure to cigarette smoke (SMD= -0.18, 95% CI: -0.30 to -0.06) decreases the serum level of mentioned lipoprotein. Additionally, active exposure to cigarette smoke (SMD=0.16, 95% CI: 0.06 to 0.27) causes a modest increase in serum level of triglyceride. However, cigarette smoke exposure does not have any effect on the level of total cholesterol and low density lipoprotein (LDL). Conclusion: The present meta-analysis showed that exposure to cigarette smoke leads to a significant decrease in the level of HDL and triglyceride but, it does not have any effect of the level of total cholesterol and LDL in children and adolescents