Determining the lymphadenopathy characteristics of the mediastinum in lung CT scan of children with tuberculosis

AbstractObjective/Background: Most tuberculosis cases in children are primary infection, with difficult and imprecise diagnosis mainly based on the existence of mediastinal lymphadenopathy. Here, we investigated the characteristics of mediastinal lymphadenopathy in lung computed tomography (CT) scans of children with tuberculosis. Methods: This cross-sectional study was performed on 75 children with tuberculosis referred to Masih Daneshvari Hospital in Tehran, Iran, from 2009 to 2013. Their medical records were investigated, and CT-scan characteristics were extracted by a radiologist. Results: Mean±standard deviation age of cases was 11.2±4.6years. CT-scan results indicated 94.7% of cases had lymphadenopathy, with lower paratracheal, upper paratracheal, hilar, and subcarinal forms observed in 81.7%, 69.1%, 53.5%, and 47.9% of cases as the most involved stations in lymph nodes, respectively. In 74.6% of patients with mediastinal lymphadenopathy, perilymph node fat inflammation (matting) was observed, with 52.11% exhibiting conglomeration. Bronchial pressure was observed in 4.23% of children with tuberculosis, and bilateral-, right-, and left-parenchymal involvement was observed in 42.7%, 25.3%, and 8% of these cases, respectively. Left- and right-pleural effusion and calcification was reported in 6.7%, 12%, and 5.6% of patients, respectively. Additionally, nearly 80% of patients exhibited mediastinal lymphadenopathy and lung-parenchyma involvement simultaneously. Lung-parenchyma involvement was significantly correlated with subcarinal (p<.001), hilar (p<.001), subaortic (p=.030), lower paratracheal (p=.037), and axillary (p=.006) stations. Conclusion: Situation of mediastinal lymphadenopathy and its synchronicity with lung-parenchyma involvement can help in differential diagnosis of pulmonary tuberculosis from other lung diseases

Usporedba dijagnostičke točnosti izravnog ispitivanja i shematske procjene lokalizacije kronične boli

None of the previous studies localized pain in comparison with graphic scheme. Our aim was to investigate the validity of direct questioning about the main pain localization in comparison with schematic evaluation. In this cross-sectional study, 331 patients, mean age 49.4±10.72 years, localized their main pain site anatomically with manikin and by direct questioning. Two methods were employed to localize pain: direct questioning and schematic evaluation (manikin). Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and odds ratio (OR) were used to compare these two methods. Study patients answered in both methods. The sensitivity and PPV were mostly in a weak range, while accuracy, specificity and NPV were mostly in good range. Kappa index was in the marginal reproducibility range. Pain in the left part of the body had a higher OR (OR=9). PLR for pain in the right part of the body was 28.03. NLR for all questions was located in the small and rarely important change probability group. Negative answer in direct questioning was more reliable than a positive one. Pain localization in the left side of the body was more reliable.Dosad nisu objavljene studije u kojima bi se lokalizacija boli uspoređivala s grafičkim prikazom. Cilj našega istraživanja bio je ispitati vrijednost izravnog ispitivanja o glavnom bolnom dijelu tijela u usporedbi s procjenom na shematskom prikazu. Ova križna studija uključila je 331 bolesnika srednje dobi 49,4±10,72 godina; bolesnici su pokazali glavno bolno mjesto na shematskom antomskom modelu ljudskog tijela i opisali ga izravnim ispitivanjem. Dakle, dvije metode su primi-jenjene za lokaliziranje boli: izravno ispitivanje i shematski anatomski model ljudskog tijela. Osjetljivost, specifičnost, točnost, pozitivna prediktivna vrijednost (PPV), negativna prediktivna vrijednost (NPV), pozitivni omjer vjerojatnosti (PLR), negativni omjer vjerojatnosti (NLR) i omjer izgleda (OR) primijenjeni su u usporedbi dviju metoda. Bolesnici su svoje odgovore dali pomoću obiju metoda. Osjetljivost i PPV uglavnom su bili u nižem rasponu, dok su točnost, specifičnost i NPV bili u dobrom rasponu. Indeks kappa bio je u graničnom rasponu reproducibilnosti. Bol u lijevom dijelu tijela pokazala je viši OR (OR=9). PLR za bol u desnom dijelu tijela bio je 28,03. NLR za sva pitanja bio je u skupini manje i rijetko važne promjene vjerojatnosti. Negativni odgovor kod izravnog ispitivanja bio je pouzdaniji od pozitivnog odgovora. Lokalizacija boli na lijevoj strani tijela bila je pouzdanija

Investigating the sequential patterns of methamphetamine use initiation in Iran

BACKGROUND: Methamphetamine (MA) remains one of the most commonly used amphetamine-type stimulants, accounting for the second most widely-used substance after marijuana. Due to increased use of MA, a wide variety of research has focused on the patterns of MA use initiation among adolescents. Nevertheless, there are few data available for people who use MA. The present study set out to assess the sequential patterns of substance use initiation in patients with MA use disorders in Iran. MATERIALS AND METHODS: This cross-sectional study described substance initiation patterns for 302 patients who used MA admitted to hospitals and psychiatric centers of Shiraz University of Medical Sciences. The study was conducted between April 2015 and June 2016. After obtaining informed consents, participants were interviewed by trained interviewers using face-to-face, semi-structured interviews. The collecting data were analyzed using the chi square tests and one-way analysis of variance (ANOVA) tests to compare the relationship between qualitative and quantitative variables, respectively. RESULTS: Out of 302 participants enrolled in the study, 16 (5.3%) and 286 (94.7%) were female and male, respectively. The mean age of participants in the study was 37.29 years. The mean age of onset of MA use was found to be 15.9 years. 46.1% of the patients started MA use before 15 years. 77.2% of the patients who used MA had family members with a history of substance use. 93.71% of the patients who used MA started substance use with tobacco, alcohol, or opium, as the most frequent substances. Tobacco, as the first substance or starting substance, exhibited the most widely-used substance (69.53% of the cases). Tobacco-alcohol-cannabis-opium-heroin-MA sequencing was significantly related to the early onset of the substance use. Early-onset substance use was significantly higher in those with lower income, primary education, and family history of substance use. No significant relationship was found between employment status with the age of onset of substance use, and different substance use with marital status. CONCLUSION: Tobacco, alcohol and opium can be considered as the main sequencing substances for initiation to MA use. Standardized measures to decrease and control access to main starting and sequencing substances, including tobacco, alcohol, and opium, can greatly help decrease the early onset of the MA use, develop suitable prevention, and establish early intervention strategies

Seroprevalence of Immunoglobulin G antibodies against pertussis toxin among asymptomatic medical students in the west of Iran: a cross sectional study

<p>Abstract</p> <p>Background</p> <p>Pertussis is a highly communicable, vaccine-preventable respiratory infection. Immune response against this disease can be induced by infection or vaccination. Protection after childhood vaccination is minimal after ten years. Our aim was to assess pertussis immunity state in a population of healthy young medical students.</p> <p>Methods</p> <p>In this seroepidemiological survey, blood samples were obtained from 163 first-year medical students in Hamedan University, Iran. Serum level of IgG against pertussis toxin (IgG-PT) was measured by Enzyme-Linked Immunosorbent Assay (ELISA) method. For qualitative assessment, IgG-PT levels more than 24 unit (U)/ml were considered positive. Data was analysed qualitatively and quantitatively considering gender and age groups.</p> <p>Results</p> <p>There were 83 males and 80 females, with a mean age of 19.48 years, Prevalence of IgG-PT was 47.6% with mean level of 71.7 u/ml (95% confidence interval: 68.1–75.3). No statistically significant difference was observed with respect to sero-positivity of IgG-PT between males and females (45 cases (54%) vs. 34 cases (42%); P = 0.06). Mean IgG-PT levels in males and females were 84 U/ml and 58.8 U/ml, respectively (P = 0.91).</p> <p>Conclusion</p> <p>A considerable proportion of our study population with a positive history of childhood vaccination for pertussis was not serologically immune to pertussis. A booster dose of acellular pertussis vaccine may be indicated in Iranian, medical students regarding their serologic conditions and outstanding role in health care systems.</p

Impact of cardiovascular risk factors on the outcome of renal transplantation

Cardiovascular diseases are common in renal transplant recipients and renal insuf-ficiency has been shown to be a risk factor for cardiovascular disease. Some studies have reported that cardiovascular risk factors may contribute to the outcome of renal transplantation. This study was performed to determine the impact of cardiovascular risk factors on the outcome of renal transplantation in Iranian subjects. This is a retrospective, observational study including patients of 20-85 years of age who had undergone renal transplantation. Parameters documented and analyzed included demographics, cardiovascular risk factors, past medical history, date of last transplan-tation, the outcome of transplant, last measured serum creatinine, cause of graft failure, rejection, and death. A total of 192 patients were analyzed including 152 in the case group (with identifiable cardiovascular risk factors) and 40 controls (transplant recipients without identifiable risk factors). The mean serum creatinine in the case and control groups were 1.33 &#x00B1; 0.13 and 1.29 &#x00B1; 0.36 mg/dL respectively (P= 0.493). Response to transplantation was categorized based on a report from the World Health Organization. Complete response to grafting occurred in the control group more than the case group (P= 0.009), while frequency of partial response to grafting was higher in the case group (0.008). A history of chronic obstructive pulmonary diseases (COPD) could significantly predict the outcome of grafting (P= 0.008) as could the occurrence of renal failure (P= 0.022). Results were consistently reproduced using multivariate cumulative log it model. Our study indicates that the measured cardiovascular risk factors do not significantly influence the outcome of renal transplantation

The effect of adjuvant vitamin C after varicocele surgery on sperm quality and quantity in infertile men: a double blind placebo controlled clinical trial

ABSTRACT ARTICLE INF

Mediastinal lymphadenopathy in pediatric tuberculosis in computed tomography scan

Background/objectives: Pediatric tuberculosis is usually a primary infection presenting mainly as mediastinal or hilar adenopathy in computed tomography (CT) scan. In this study, we study the distribution and other CT scan characteristics of mediastinal lymphadenopathy in childhood tuberculosis. Methods: Chest CT scans of 75 cases of pediatric tuberculosis at Masih Daneshvari Hospital in Tehran, Iran, from 2009 to 2013 were studied regarding characteristics of mediastinal lymphadenopathy. Results: Mean ± standard deviation age of cases was 11.2 ± 4.6 years. Lymphadenopathy (mediastinal/hilar) was detected in 94.7% of cases. Most of the lymphadenopathies were located in the lower paratracheal (81.7%), upper paratracheal (69.1%), hilar (53.5%), and subcarinal (47.9%) stations. Perilymph node fatty stranding, lymphadenopathy conglomeration, bronchial pressure by the lymph nodes, and lymph node calcification were noted in 74.6%, 52.11%, 4.23%, and 5.6% of cases, respectively. Bilateral, right, and left lung parenchymal involvement were reported in 45%, 25%, and 8% of cases, respectively. Lung parenchymal involvement was significantly correlated with lymphadenopathies in subcarinal (p <0.001), hilar (p <0.001), subaortic (p = 0.03), lower paratracheal (p = 0.037), and axillary (p = 0.006) stations. Right- and left-sided pleural effusions were observed in 12.7% and 7% of cases, respectively. Conclusion: Attention to distribution and characteristics of mediastinal lymphadenopathy can help differentiate tuberculosis from other causes of pediatric mediastinal lymphadenopathy

Comparing Diagnostic Accuracy of Direct Questioning Versus Schematic Evaluation of Chronic Pain Localization

None of the previous studies localized pain in comparison with graphic scheme. Our aim was to investigate the validity of direct questioning about the main pain localization in comparison with schematic evaluation. In this cross-sectional study, 331 patients, mean age 49.4±10.72 years, localized their main pain site anatomically with manikin and by direct questioning. Two methods were employed to localize pain: direct questioning and schematic evaluation (manikin). Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and odds ratio (OR) were used to compare these two methods. Study patients answered in both methods. The sensitivity and PPV were mostly in a weak range, while accuracy, specificity and NPV were mostly in good range. Kappa index was in the marginal reproducibility range. Pain in the left part of the body had a higher OR (OR=9). PLR for pain in the right part of the body was 28.03. NLR for all questions was located in the small and rarely important change probability group. Negative answer in direct questioning was more reliable than a positive one. Pain localization in the left side of the body was more reliable

A Scientometric Analysis of 20 Years of Research on Breast Reconstruction Surgery: A Guide for Research Design and Journal Selection

BackgroundBreast reconstruction refers to the rebuilding of a woman's breast using autologous tissue or prosthetic material to form a natural-looking breast. It is increasingly offered to women undergoing mastectomy for breast cancer. However, there is no systematic analysis available for the expanding area of research on breast reconstruction.MethodsA bibliometric method was used to obtain a view of the scientific production about breast reconstruction by data extracted from the Institute for Scientific Information (ISI). Specific parameters were retrieved from the ISI. Articles about breast reconstruction were analyzed to obtain a view of the topic's structure, history, and document relationships using HistCite software. Trends in the most influential publications and authors were analyzed.ResultsThe number of articles was constantly increasing. Most highly cited articles described the methods of flap construction in the surgery. Other highly cited articles discussed the psychological or emotional aspects of breast reconstruction, skin sparing mastectomy, and breast reconstruction in the irradiated breast.ConclusionsThis was the first breast reconstruction scientometric analysis, representing the characteristics of papers and the trends of scientific production. A constant increase in the number of breast reconstruction papers and also the increasing number of citations shows that there is an increasing interest in this area of medical science. It seems that most of the research in this field is focused on the technical aspects of surgery