Iranian Journal Of Pathology
Volume:3 Issue: 3, Summer 2008

Improved and modified automation will require the development of smart process control systems that provide on-line decisions to release patients’ test results based on high analytical quality assurance formula. We collected patients’ test results from 10840 healthy subjects based on 1.96z as truncation limit for 29 common haematochemical analytes at a regional reference laboratory. Computer simulation studies by EZ rulesTM and EZ runsTM software were performed to generate operating specification charts (OPSpces) that consider truncation limits set at 3(Spop) and control limits set at 3 Spop/n1/2 and number of patient subgroups which varied from 10 to 480 depending on the ratio that varied from 1.58 to 19.75. On the basis of the test parameters defined and the workload expected in our regional laboratory, average of patients (AOP) algorithms would be expected to be useful for monitoring run length on analytical systems that test for ALP, ALT, AST, total bilirubin, calcium, creatinine, glucose, hematocrit, hemoglobin, potassium, sodium, TSH and urea. These tests provide high potential capability indicating lowPfr, highPed and high analytical quality assurance (AQA) with low control observations for applying AOP algorithms to monitor run length. Our investigation revealed that approximately fifty percent of commonly requested aematochemical tests could achieve high capability in order to establish AOP method to maximize analytical run length.

Although transfusion therapy has lead to great improvement in longevity for hemophiliacs, but there have been tragic setbacks especially from transmission of human immunodeficiency virus (HIV) and hepatitis C virus (HCV), HIV was reported to increase the rate of HCV-related liver failure by 4.2 times. In this study, we aimed to determine the seroprevalence of HIV and HCV, the association of HCV with abnormal liver tests, impact of HIV on HCV-related abnormalities and the distribution of HCV genotypes in Iranian hemophiliacs.Patients and In a cross-sectional study, we determined virological, clinical and epidemiological characteristics for HIV and HCV infection of 236 hemophiliacs attending our center. Data were analyzed using Chi-square test. Ten (4.7%) out of 211 patients tested were HIV seropositive and 145 (83.3%) were HCV seropositive. All tested positive HIV patients also had HCV. HCV seroprevalence was significantly higher in patients with hemophilia A and B as compared to other congenital coagulopathies and it was directly related to coagulation severity. HCV seroprevalence was lower in hemophiliacs with positive HBsAg (p = 0.03) but it did not differ by HBcAb or HBsAb results. HCV genotype 1a (48.5%) was predominant type and genotype 3a (33.3%) was also common. Frequency of abnormal aspartate aminotransferase and alanine aminotransferase liver enzymes was significantly higher in the HCV positive group (p = 0.006). This study provides evidence that hepatitis c virus infection is a major problem for Iranian hemophiliacs and it has higher prevalence in hemophiliacs with higher age, more severe coagulopathies, abnormal alanine aminotransferase level, and human immunodeficiency virus coinfection.

Anemia is a common manifestation of human immunodeficiency virus (HIV) infection, occurring in approximately 30% of patients with asymptomatic infection and in as many as 75% to 80% of those with AIDS. Anemia has been associated with decreased quality of life and decreased survival. In this study we aimed to determine the prevalence and related factors of anemia in HIV-infected patients. A total of 143 HIV positive patients who referred to behavioral disease consulting center in Tehran were screened for anemia. Mild to moderate anemia was defined as hemoglobin (Hb) 8-14g/dl for men and 8-12g/dl for women; severe anemia was defined as Hb less than 8g/dl for both males and females. sociodemographic data were collected using a questionnaire. In all patients, CD4 lymphocytes counting were done by flowcytometry. It was found out that 143 HIV positive patients with a mean age of 37.1± 2 years were enrolled in our study. The mean Hb level was 13.5 ± 2.1 g/dl. Mild anemia occurred in 46% of subjects while severe anemia was not observed. There was not any significant difference between patients with and without anemia regarding age, gender, stage of the infection, CD4 cells count and concurrent anti-retroviral therapy. We also found significant difference between anemia and risk behaviors for HIV acquisition. Our results showed that mild to moderate anemia was frequent in HIV positive patients but severe anemia was not prevalent in this study population.

The concept of immediate occlusal loading with dental implants offers several advantages. In this research, the effect of type of restoration on Osseointegration rate of dental implants was histologically evaluated. Three months prior to implantation, the lower premolar teeth of 15 dogs were extracted. Then, 3 to 4 Maestro™ implants were placed in the healed extraction sites for each dog (n=48). Dividing the dogs into 3 groups, the implants were either loaded 48 hours later, with metallic or prefabricated acrylic crowns, or were left unloaded until the time of sacrifice. Three months after implant insertion, the animals were sacrificed and the samples were investigated to define the Osseo integration rate, lamellar and woven bone percentage and local inflammation of the regenerated bone. No significant difference in the observed criteria was observed among the three groups (p>0.05); however, the unloaded group had the highest osseointegration rate and the group with metallic crown loaded had the least. The prosthesis type had no significant effect on the implant success rate (p>0.05). Lamellar and woven bone percentage of regenerated bone also did not differ in the three groups (p>0.05). One implant from each group failed in this study. Compared to unloaded implants, bone regeneration seems to have similar histological haracteristics around immediately loaded dental implants and if properly carried out, these two kinds of restoration materials do not seem to affect the osseointegration and the bone regeneration process.

Chronic rhinosinusitis (CRS) is one of the most common chronic diseases. In the past decades, there has been an increase in fungal infections of sinuses and fungal rhinosinusitis (FRS) has been diagnosed more frequently. Knowing the fungal flora and its prevalence in CRS patients will allow a better understanding of this disease, permitting a correct diagnosis, treatment and formulating its prognosis. This study was performed to assess the fungal flora and its prevalence in CRS patients. In this prospective study fungal cultures were obtained from nasal and paranasal sinuses mucus of 100 patients suffering from CRS and 40 controls who did not show any evidence of CRS. In addition, in CRS patients, paranasal sinuses mucus and tissue were histologically investigated for evidence of eosinophilic granulocytes and fungal elements besides fungal culture. Fungal cultures of nasal mucus were positive in 62.5% and 60% of cases and controls respectively. Positive fungal cultures of paranasal sinuses mucus were seen in 49% of cases and 5% of controls. Aspergillus was the most frequent, followed by Penicilium and Cladosporium in both nasal and paranasal sinuses mucus culture. Eosinophilic mucin was found in 90% of CRS patients.

Oral cancer accounts for less than 3% of all cancers. Despite recent improvement in diagnostic and treatment methods, the overall survival of the disease is unfavorable. Several studies have been performed to assess factors influencing lymph node metastasis and prognosis. The aim of this study was to evaluate some clinical and pathological factors influencing lymph node metastasis in oral squamous cell carcinoma (SCC). In this retrospective study, 111 cases of oral SCC registered from 1991 to 2001 were retrieved from the archive of the Department of Pathology of Cancer Institute. Cases were divided into two groups based on the presence of lymph node metastasis. Patients’ pathological reports and medical records were reviewed and variables such as age, gender, occupation, disease duration, site and greatest diameter of tumor and histopathologic grade were compared between metastatic and non-metastatic groups. Data were analyzed using SPSS package and t, chi square, Mann-Whitney and Fisher’s exact test with p<0.05 as the limit of significance. Among the studied factors, patients’ gender (female), the disease duration (more than 12 months) and tumor size based on T1–T4 category were significantly related to lymph node metastasis. Other factors failed to show any correlation with lymph node metastasis. Based on the results of this study, women with large tumors lasting more than 12 months might be of greater risk for lymph node metastasis.

Histological grading has prognostic and therapeutic implications in meningioma. However, histological criteria are sometimes not fulfilled to predict the biological behavior of meningiomas. P63 gene is a novel P53 family member, known as tumor suppressor factor, with multiple isoforms and shows high expression in many normal and neoplastic human tissues. In this study, we investigated expression of P63 in different histological grades of meningiomas. For this purpose, we studied and analyzed the immunohistochemical expression of P63 by a monoclonal antibody (clone 4A4) that recognizes all P63 isoforms in 52 cases of meningioma including WHO grade I (42 cases), grade II (7 cases) and grade III (3 cases). Correlation between histological grade and parameters like cell nuclear immunoreactivity to P63 antibody, age, gender and site of meningioma was analyzed by parametric and non-parametric statistical tests. Among 52 patients analyzed, there were 35 females (67.3 %) and 17 males (32.7%) between 13 and 75 years old. Histological grading revealed 42 cases (80.8%) as WHO grade I, 7 (13.5%) as grade II and 3 (5.8%) cases were grade III. Expression of P63 protein was found in 83.2% of cases with grade I but in grade II and III, all of the cases were immunoreactive, so as in grade III, 100% of cases were with higher percent of nuclear reactivity in our study. Correlation between histological grade and nuclear immunoreactivity was highly significant (p=0.001). We conclude that the immunohistochemical staining of P63 will be valuable in discrimination of different grades of meningiomas.

The frequency and pattern of eye neoplasms differ in various geographic areas. Our aim was to determine the distribution of patient age, gender, ocular tumor origin, location and histological type in our region. In this cross-sectional study, all of the 384 eye globe enucleation cases carried out during a 10-year period in Farabi Medical Center in Tehran were selected and reviewed. The inflammatory and non-tumoral conditions were excluded. Out of 350 primary tumors, 344 (98.6%) were malignant including 248 cases of retinoblastomas (70.9%), 76 cases of (21.7%) melanomas and 14 cases of (4%) squamous cell carcinomas. Mean ages for these tumors were 3.2, 51 and 64.8 years respectively. Overall the tumors were 1.15 times more frequent in left eye and 1.53 times more common in males. Out of 248 cases of retinoblastomas, only 12 (4.8%) cases were bilateral (mean age 3.46 years; male to female ratio 1.4:1). Some rare cases in our series included a primary non-Hodgkin lymphoma of choroid, two choroidal leiomyomas and an adenocarcinoma of the retinal pigment epithelium. The overall frequency of the three most common primary malignancies in our series was similar to the reported Asian countries but slightly differed with western countries in terms of lower incidence of melanoma here. Also bilateral retinoblastoma was less frequent here and occurred in a slightly older age. The actual frequency of metastatic eye tumors could not be evaluated precisely due to lack of systematic autopsy data.

The anemia of ESRD is a complex disorder, associated with serious complications, which increases patients’ mortality and morbidity. Treatment of this anemia with recombinant human erythropoietin (rHu-EPO) is well established. This clinical trial study was conducted within 20 months, from May 2005 to January 2007, in order to evaluate the efficacy of PDpoetin (rHu-EPO manufactured in Iran) in anemia correction of hemodialysis patients. The study population was composed of 80 patients, aged 22-84 years (with a mean of 49.5 ± 17.5 years), who were 60% male and 40% female. Data were collected by using a questionnaire and a consent form is signed by each patient. All data analysis were carried out using SPSS software and statistical t-test. We administered 50-100 U/kg (up to 300 U/kg in resistant cases) of PDpoetin, 3 times per week, subcutaneously. Then, we followed patients by weekly blood sampling for Hct and Hgb measurement. PDpoetin raised Hct>1% and Hgb>0.3 g/dl per week in 81% and 79% of patients with CRP<5 mg/dl, respectively. In patients with CRP≥5 mg/dl, these values were 56% and 54%. The mean values of Hct and Hgb rise per week were 1.4 ± 0.2% and 0.4 ± 0.06 g/dl (p = 0.0004 and p = 0.0002, respectively), without any statistically significant difference in both gender. PDpoetin may be an appropriate substitute for commersially availabele rHu- EPOs(Eprex). Further research studies are recommended.

Vancomycin is frequently the antibiotic of choice for the treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). For the last years, the incidence of vancomycin-intermediate S. aureus (VISA) and vancomycin-resistant S. aureus (VRSA) has been increased in various parts of the world. The present study was carried out to determine the presence of VISA and VRSA in Tehran. A total of 164 S. aureus strains were isolated from clinical specimens in four university-affiliated hospitals in Tehran from November 2006 to June 2007. Minimum inhibitory concentration (MIC) of vancomycin of isolates was determined by agar dilution method. Vancomycin (6 mg/l) screen agar plate method and E-test were used to confirm presence of resistance to vancomycin. Disc diffusion agar test was also used to detect resistance to other antimicrobial agents. Only one VRSA (MIC 256 mg/l) was detected and three strains with MIC 4 mg/l considered VISA according to recent CLSI breakpoints for vancomycin. Only VRSA strain had shown growth on vancomycin screen agar plate and was also resistant to several antimicrobial agents but susceptible to quinupristin/dalfopristin, linezolid, chloramphenicol, mupirocin and cotrimoxazole. Isolated VISA were also multi-resistant but showed susceptibility to quinupristin/ dalfopristin, linezolid, chloramphenicol and mupirocin. Detection of vancomycin resistance in Iranian S. aureus isolates emphasizes the challenges confronted by the infection control specialists in hospitals in Iran as well as causing problems in the treatment of patients with S. aureus infections.

Gastrointestinal aspergillosis most often occurs in the setting of disseminated infection from a primary pulmonary site and primary gastrointestinal aspergillosis is an unusual presentation. We report a 7 year old female child with aplastic anemia, who was under treatment but experienced periods of neutropenia. She had no evidence of respiratory aspergillosis before the onset of abdominal symptoms including severe abdominal pain and rectorrhagia.The patient died of septic shock two weeks after emergency surgery for rectal bleeding. Although a rare condition, primary gastrointestinal aspergillosis should be considered in differential diagnosis of gastrointestinal symptoms in neutropenic patients.

A male patient with acute renal failure (ARF) due to large B-cell non-Hodgkin lymphoma infiltration of kidney is presented. The diagnosis was suspected because of coincidence of ARF and tumor lysis syndrome non-responsive to conservative renal therapies. A renal biopsy confirmed diagnosis and appropriate chemotherapy led to complete improvement of renal function.