مجله علوم پزشکی رازی
سال هجدهم شماره 7 (پیاپی 88، مهر 1390)

Differentiation between amyotrophic lateral sclerosis (ALS) and cervical spondylotic myelopathy (CSM) not only for those similar clinical features but also for different handling is very important in clinical practice. Considering that EMG of the sternocleidomastoid muscle (SCM) is using for differential diagnosis of these diseases in Iran, present study was aimed to evaluate the sensitivity of sternocleidomastoid muscle electromyography in differential diagnosis of ALS from CSM. We conducted a retrospective cohort study. Subjects (34patients) were identified from suspected ALS or CSM patients who referred to Loqhman hospital and evaluated with using of the sternocleidomastoid muscle electromyography (SCM-EMG) between March 2006 and February 2008 as part of the diagnostic workup. Clinical characteristics and MRI results were derived from subject’s medical records. Follow-up clinical evaluation during two years after initial diagnostic evaluation was available as a gold standard for confirmation the EMG results. We used two way tables for calculating sensitivity. SCM-EMG was abnormal in 10 (29.4%) patients, all of whom were subsequently diagnosed with ALS. The sensitivity of SCM-EMG was 0.71 (95% CI, 0.42– 0.91) for the diagnosis of ALS. Although our findings suggest that SCM-EMG is an extremely useful adjunct for the diagnosis of ALS, but further studies with larger sample size is needed for its application as a useful test “Ruling in” for the diagnosis of ALS.

Hbs-Ag positivity rates in dialysis patients correlate with endemicity in the general population. There is a subset of patients with occult HBV infection that defined as the presence of detectable HBV-DNA by PCR in patients who are negative for Hbs-Ag. We decided to detect the occult HBV cases in our hemodialysis patients. With support of charity society of renal patients of Qazvin, a cross sectional study was scheduled. We tested all the 134 hemodialysis patients in Buali Hospital of Qazvin university of medical sciences for viral hepatitis B in 1 year period. All the patients were chronic hemodialysis patients. Then Hbc-Ab and Hbs-Ag were detected by ELISA tests. Duplication is considered to have true test results. After completion of this stage, the aliquoted samples were tested for qualitative HBV-DNA (PCR). The positive cases for HBV-DNA were tested again in a referral center to ensure of test results. 43% were female and 57% were male cases. We had 5 positive cases for hepatitis B by ELISA tests (3.7%) that 4 of them were Hbc-Ab and HBV-DNA positive also as expected, although 1 of them had negative test result by PCR test unusually. We detected 4 (3%) another positive PCR test results for HBV that had negative tests for Hbs-Ag, called occult HBV cases. 3 (75%) of these occult cases were Hbc-Ab negative and known as seronegative occult cases. No significant association was found with the duration of hemodialysis, age or sex and HCV positivity in these cases.Age of occult HBV cases was significantly more (P=0.02). As mentioned most of our occult HBV cases were seronegative. It seems that Hbc-Ab detection is not sensitive test in these cases. Segregation of positive HBV cases in hemodialysis units is mandatory and new protocols may be considered to detect the cases for segregation in the future.

Probiotics are defined as different microorganisms that may have positive effects on preventing or treatment of special pathologic conditions. The actions of lactic acid bacteria are species and strain specific, and depend on sufficient numbers of bacteria being available in the intestines. The difficulty in identifying and classifying strains has complicated research, since benefits may only pertain to particular strains. Since there is no research regarding Iran’s probiotics up to now thus, the present study was designed to investigate the effect of Lactobacillus brevis on cutaneous wound healing. In this experimental study, 22 strains of Lactobacillus isolated from dairy-traditional products of exopolysaccharide production are investigated by phenol-sulfuric acid method. Lactobacillus brevis, which had high exopolysaccharide (EPS) production, was selected. A full-thickness square wound (1.5 × 1.5 cm) was made on the back of each rat (45 rats in 3 groups). Two groups, control and experimental were treated by eucerin and eucerin contained 1×1o 11 CFU/ml Lactobacillus brevis, but the negative-control group did not receive anything. Rats were killed on days 1, 3 and 14 and wound samples were collected for histological and statistical studies. The data were expressed as mean±Standard deviation. Statistical analysis was performed with ANOVA. The percent of wound healing (91.76%) and inflammation in experimental group on day 14 as compared to control (74.33%) and negative groups (73.51%) was significant (p<0.001). The numbers of neutrophils in experimental group were reduced in later phase of wound healing as compared to control and negative groups. The current study showed a significant reduction in inflammation and a significant acceleration in wound healing on the rats treated by Lactobacillus brevis as compared to control and negative control groups. Further studies are required for detail mechanism of Lactobacillus brevis during wound healing.

Different criteria have been used for classification of SLE as ACR and BW criteria (BW). In BW criteria every item has score. The outcome of this study is comparison of ACR with BW criteria diagnosis of SLE. All SLE patients who referred to rheumatology clinic of Rasool Akram hospital were enrolled in this study that was from 2004 to 2006. All data recorded of medical file and specialists to rheumatologist diagnosis were enrolled in this study. All patients (67:2 m, 65 f) were diagnosed by rheumatologist as a SLE. 61 patients full filled ACR criteria (91%) and 62 patients full filled BW criteria (92%). Sensitivity and specificity of BW criteria was 98% and 67% respectively. Positive predictive value and negative predictive value of BW Criteria was 96.7% and 80% respectively. Agreement between two criteria was 0.703 according to kappa (0.703) and P value was<0.001. In this study sensitivity of BW criteria was more than ACR criteria (98% versus 91%) and specificity BW criteria was less than ACR criteria (67% versus 71.9%).

Atypical clinical manifestations and radiologic images of pulmonary tuberculosis are common in elderly. To investigate the differences in the clinical, radiologic and laboratory features of pulmonary and pleural tuberculosis in older patients, as compared to younger patients. The medical records of patients with documented pulmonary tuberculosis in Rasoul-e-Akram hospital from 2005 through 2010 were analyzed. Data included sex, age, medical comorbidities, symptoms and signs, laboratory data, radiographic findings, tuberculin skin test (TST) and sputum smears and bronchoalveolar lavage (BAL) for AFB results. Statistical significances were analyzed by student t test and chi2 test. Among 285 patients with documented tuberculosis, 126 were 65 years of age and older, and 159 under 65 years of age. A lower prevalence of fever, night sweating, hemoptysis, anorexia, pleuritic chest pain, cavitary lesion in upper lobes, positive TST and positive acid fast bacilli in sputum and BAL were detected among older patients (p<0.05). In addition, the older patients had a greater prevalence of dyspnea (p<0.001) and some comorbidities, such as diabetes mellitus, COPD, and renal failure (p<0.05). This study showed the main differences of pulmonary tuberculosis in the elderly, compared to young patients that should be considered during the diagnostic assessment.

Primary Hyperoxaluria is one of the causes of multiple kidney stones and renal failure in low age groups. Changes in structure of bone in these patients included two types: bone oxalosis and renal osteodystrophia. Case report : The patient was a child aged 10 years old under dialysis due to renal failure. He had a fracture of femoral neck and two times subtrochanteric fracture. One of the most places for fracture in these patients is proximal of femur. Because of bone fragility in these patients, they should avoid heavy activities. Occurrence of fracture should be managed and followed carefully after surgery in these patients.