Group A �-hemolytic streptococcal infection in children and the resultant neuro-psychiatric disorder; a cross sectional study; Tehran, Iran

Introduction: Group A Beta-Hemolytic Streptococcus (GABHS) can induce PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection). GABHS is the most important and common bacterial cause of acute pharyngitis in Iranian children. We studied the role of GABHS (anti-streptococcal antibodies) in suspected cases of PANDAS in a cross sectional studies. Methods: Across sectional study was done in 2 pediatric psychiatric/and neurologic clinics in Tehran (Rasul Akram and Aliasghar Hospital) during 2008-2010. We studied serum antistreptococcal antibodies (anti streptolysin O, anti Deoxyribonuclease B, and anti-streptokinase (ABcam-ELISA, USA) in 76 cases with psychiatric manifestation (OCD, ADHD) in compare with 39 healthy controls. These antibodies were studied in 53 cases with movement disorders (Tic/Tourette syndrome) in compare with 76 healthy controls. Sensitivity, specificity and positive predictive value of tests were calculated. Results: In movement disorders ASOT, Anti-DNase and Anti streptokinase was significantly higher than controls (p 200IU/ml) had 75 sensitivity; 84 specificity and 80 PPV; Antistreptokinase (cut off level> 332 IU/ml) had 34 sensitivity; 85 specificity, and 72 PPV; Anti-DNase (cut off level> 140IU/ml) had 70 sensitivity; 99 specificity and PPV 90 for differentiating the group. ASOT, Anti-DNase and Anti streptokinase titer was significantly higher than controls (p<0.0001, p=0.000, p<0.0001). ASOT had 90 sensitivity; 82 specificity, PPV 92; Anti streptokinase: 82 sensitivity; 82 specificity, PPV 95; Anti DNase: 92 sensitivity; 82 specificity, PPV 92 for differentiation the cases from normal controls. Discussion: These findings support that a post infectious immune mechanism to GABHS may play a role in the pathogenesis of PANDAS in our children. A combination of throat culture, rapid antigen detection test, and serologic testing for GABHS is required to achieve maximum sensitivity and specificity for diagnosis. We prefer to use antibiotic prophylaxis in PANDAS cases for preventing recurrent streptococcal infections. Ongoing research is needed for identifying optimum diagnostic, prevention and therapeutic approach especially, aggressive treatment (intravenous immunoglobulin, plasmaphresis)

Diagnostic value of the level of interleukins in cerebrospinal fluid in children meningitis

Background: Cerebrospinal Fluid (CSF) culture for distinction between aseptic and bacterial meningitis can be difficult and long-term, and other diagnostic methods are under studying. This study aimed to assess the diagnostic value for the levels of Interleukin 1 (IL-1), IL-6 and IL-8 of CSF in the children and adolescent with meningitis. Methods: Fifty-one patient with meningitis between one month and 18 year included in a Cross-Sectional Studies in the Rasul Hospital, Tehran, from 2012 to 2014. All of samples underwent aspiration of CSF. The routine tests performed that include culture; coloring and biochemical of CSF. The concentrations of IL-1, IL-6 and IL-8 were determined by Enzyme-linked immunosorbant assay (ELISA) method and all of data were analyzed. Results: Frequency of bacterial and aseptic meningitis was equal (49). 64.7 of samples were boys and gender had not different between two bacterial and aseptic group (P=0.7). Mean (±SD) of the age in total was 358.46±858.40, and bacterial group had a higher mean of age than aseptic group (P=0.047). The level of IL-1 was 10.87±37.04 pg/ml in bacterial and 0.55±1.64 pg/ml in aseptic group, that had not different (P=0.168). The level of IL-6 was 90.51±139.3 pg/ml in bacterial and 21.36±67.84 pg/ml in aseptic group, that had significant different (P=0.030). The level of IL-8 was 365.40±765.52 pg/ml in bacterial and 50.66±59.34 pg/ml in aseptic group, that had significant different (P=0.047). Diagnostic value of IL-1 was noted in the 80.77 of bacterial and 68.00 of aseptic group that had not different (P=0.349). Diagnostic value of IL-6 was noted in the 53.85 of bacterial and 64.00 of aseptic group that had not different (P=0.572). Diagnostic value of IL-8 was noted in the 80.77 of bacterial and 28.00 of aseptic group that had significant different (P=0.000). There was not different between two group of CSF variables include coloring degree, WBC and RBC index, glucose and protein. Conclusion: Although the concentration of IL-6 and IL-8 was higher in bacterial meningitis than in aseptic patients, only IL-8 had suitable diagnostic value for distinction between different types of meningitis. © 2015, Tehran University of Medical Sciences. All rights reserved

Th1 and Th2 cytokine gene expression in atopic and nonatopic patients with nasal polyposis

The pathogenesis of nasal polyps has been debated for many years. The lymphocytes that infiltrate nasal polyps have been identified as predominantly memory T cells in an activated state, and these cells produce a mixed cytokine pattern of T1 helper (Th1) and T2 helper (Th2) cells. We conducted a prospective study to compare the expression levels of some Th1 and Th2 cytokines in atopic and nonatopic patients. Our study population consisted of 75 adults-42 men and 33 women (mean age: 38 yr)-with nasal polyposis. Patients with an allergy were distinguished from those without an allergy on the basis of the history, the results of skin-prick testing, and measurement of total IgE serum concentrations. Based on these criteria, patients were divided into two groups: atopic (n = 38) and nonatopic (n = 37). Levels of cytokine gene expression in the atopic patients were compared with those of the nonatopic patients by real-time polymerase chain reaction. Statistical analysis found no significant differences in the rate of interleukin (IL) 10 and IL-12 gene expression between the allergic and nonallergic patients. On the other hand, rates of interferon gamma and IL-4 gene expression were significantly higher in the atopic patients (p = 0.03 and p = 0.02, respectively). Our research suggests that an imbalance of Th1 and Th2 cells plays an important role in the pathophysiology of nasal polyps. Although nasal polyposis is a multifactorial disease associated with several different etiologic factors, chronic persistent inflammation is undoubtedly a major factor, regardless of the specific etiology. © 2015 Vendome Group

The Comparison of TH1 and TH2 Cytokines Gene Expression in Allergic and Non-Allergic Patients With Nasal Polyps By PCR

Background: Too many studies are in the process of determining the probable role of immune system in the etiopathogenesis of nasal polyposis. This study was designed to identify the probable participation of Th1, Th2 lymphocytes in the induction and progression of nasal polyposis.Methods: Seventy-five patients, 42 male and 33 female, with nasal polyposis were examined for total serum IgE, specific serum IgE and reaction to skin test for differentiating allergic from non-allergic participants in Rasoul Akram Hospital during 2010. To determine the possible correlation of allergic reactions in the upper respiratory tract and nasal polyposis, cytokine gene expression was evaluated on the extracted RNA by RT-PCR. The data were analyzed by using c2, independent t-test, correlation and Receiver operating characteristic (ROC) curve.Results: The mean age of participants was 38 years (18-81 years). IFN-γ and IL-4 gene expressions were more prevalent in allergic than non-allergic individuals (IFN-γ: 39.5% vs. 14.2%, P=0.3 and IL-4: 44.7% vs. 18.9%, P=0.02, respectively). IL-10 and IL-12 (P35 and P40 fractions) genes were not significantly different between the two groups. IL-10 and IL-12 (P35, P40) genes did not differ significantly either.Conclusion: This research suggests that overproduction of cytokines and an imbalance of Th1 and Th2 cell production may play an important role in the pathophysiology of allergic or non-allergic nasal polyp formation. Thus, although nasal polyposis is a multifactorial disease with several different etiological factors, chronic persistent inflammation is undoubtedly a major factor irrespective of the etiology

Detection of fluoroquinolone genes and spread of antibiotic resistance profile of Enterococcus strains isolated from clinical specimens

Enterococci are a significant source of hospital-acquired infection with Enterococcus faecalis and Enterococcus faecium being the third and fourth most common nosocomial pathogens in the world. Enterococci infections have become important to healthcare practitioners due to their high rate of antibiotic resistance. We aimed to determine the fluoroquinolone genes and spread of the antibiotic resistance profile of Enterococcus strains isolated from clinical specimens. This study was performed on 101 clinical samples of enterococci species isolated from patients in different hospital wards (Rasol Akram hospital in Tehran, from Jun 2018 to Apr 2019). Antibiotic susceptibility tests using the disc diffusion method and biofilm formation assay were performed on isolated species. To detect the presence of resistant genes, polymerase chain reaction (PCR) assay was performed for the detection of Gyr a, Gyr b, Par E, and Par C. In the isolation of 76.2 E. faecalis (77 samples) and 23.8 (24 samples) E. faecium from the clinical samples. Also, antibiotic susceptibility tests demonstrated that the Enterococcus species had the least and the most sensitivity to nalidixic acid/gentamicin and vancomycin, respectively. However, no correlation was found between biofilm formation ability and the region of isolated samples (P-value = 0.3). The prevalence of parE, gyrB, and parC genes were 100, 40.6, and 15.8, respectively among ciprofloxacin resistant enterococci species. These results show a higher occurrence of parE, and gyrB than ciprofloxacin resistance genes in Enterococcus species. This study also revealed an alarmingly high frequency of multidrug-resistant enterococci in clinical samples and the ability of biofilm formation in enterococci which can increase bacterial pathogenicity in patients. © 2020 Elsevier Inc

A case report of prostate cancer with leptomeningeal metastasis

BACKGROUND: Prostate cancer is the most prevalent cancer in men. However, leptomeningeal involvement by prostate carcinoma is a rare event. CASE: Here, we report a 69‐year‐old patient with castration‐resistant metastatic prostate cancer who presented with headache and ataxia. Brain MRI revealed a huge invasive interaxial mass at right occipital lobe with diffuse thickening and enhancement of meninges, the arachnoid, and the pia mater, and he was diagnosed with leptomeningeal carcinomatosis. The patient received whole brain radiotherapy. CONCLUSION: Despite the fact that brain and leptomeningeal metastases are not very common in patients with prostate cancer, signs and symptoms of nervous system disorders should be assessed carefully, and consideration of such unusual metastases must be considered