Tehran University Medical Journal

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Background: Multiple sclerosis (MS) is a chronic disease that begins most commonly in young adults and is characterized pathologically by multiple areas of central nervous system (CNS) white matter inflammation, demyelination, and glial scarring. The most valuable aid for diagnosis is magnetic resonance imaging (MRI). New type of MRI has been developed on the basis of molecular diffusion which capable of detecting acute and active lesions. Early diagnosis and treatment is possible to stop or slow down progression of disease. The aim of this study is to compare the findings of conventional and diffusion- weighted (DW) MRI in detection cerebral lesions of MS.

Methods: Thirty patients with clinically definite MS and 30 healthy volunteers were studied in a descriptive-prospective survey over a twelve-month period of time. Conventional and DW MRI were used in both groups. Total number, morphology, location and the mean size of the intra-cerebral plaques of MS were compared between group. The sensitivity and the specificity of both imaging methods in detecting these plaques were determined.

Results: Thirty patients with MS with the mean age of 32.76±8.79 years and 30 healthy individuals with the mean age of 32.75± 9.23 years were enrolled. Plaque within the brain was significantly higher by the conventional method (P< 0.05). Ovoid lesions were greater in number in the conventional method group. More lesions were detected by the conventional method in the areas of periventricle, centrum semiovale and corpus callosum. Regarding the size of plaque, the minimum measurement was significantly lower in the conventional method group. The sensitivity of both methods was 100%. The specificity of conventional and DW MRI was 86.6% and 96.6%, respectively.

Conclusion: In our study the sensitivity of both methods was the same but the specificity of DW MRI was higher. DW MRI may detect lesions which are not detectable by the routine methods.

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Background: Infectious diseases are problematic in all around the world especially in the developing countries and early diagnosis of infections and one etiologic agents has a major role in the treatment of one patients. There are some culturing methods consist of conventional, semiautomatic and automatic. One of automatic methods is BACTEC system worked by fluorescent technology and Co2 production of organisms in culture media.
Methods: This study is based on observational-descriptive method with simple convenient sampling. We analyzed 262 samples of body sterile fluids of patients admitted in pediatric and internal wards of a university (Rasol- Acram) Hospital. They are consisting of 150 blood, 46 synovial, 32 CSF, 24 pleural, and 10 peritoneal samples.
Results: There were no differences between two sex in BACTEC and Conventional methods. Average age of patients with positive and negative culture in two methods had not differences. 72 (27.5%) samples were positive that 32 (12.2%) samples only in BACTEC method, 4 (1.5%) in conventional method and 36 (13.7%) in two methods had statistical differences (p=0.003). That means positive cultures are seeing in BACTEC more than Conventional method. Comparison of two methods in positive blood culture samples had statistical differences (p=0.02) but no statistical differences in other body fluids were seen. i. e. positive cultures were seen in BACTEC more than Conventional method. Positive culture in these two methods had statistical differences in antibiotic utilization (p<0.001). Positive culture in antibiotic utility were seen in BACTEC more than Conventional method. The average time of culture to become positive were 17.5+ 5.88 hours in BACTEC against 62.36+ 13.98 hours in Conventional method. Contamination was seeing in 4 samples in BACTEC and 2 in Conventional method that had no significant differences.
Conclusion: According to these data organism detection in BACTEC culture media from body sterile fluids overall and specially from blood is more successful than Conventional method. It is a better method in antibiotic utilization. BACTEC can isolate organism in shorter duration than Conventional method. BACTEC can facilitate early and accurate diagnosis of infectious etiology, shorten duration of hospital stay and decrease mortality and morbidity and cost.

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Background: The papanicolaou (pap) smear has been used to screen cervical cancer since 1940. Recently, a number of new technologies have been developed to improve the detection of cervical cancer and its precursors. However, there is substantial controversy about whether the new tests offer meaningful advantages over the conventional pap smear. Ideally, these new tests will increase the early detection of meaningful pap smear abnormalities, reduce the number of unsatisfactory smears and provide fewer ambiguous results.

Methods: In this prospective study the result of Liquid- based cytology smears (Liquid prep method) compared with conventional pap smears in terms of adequacy and ASC diagnosis in 289 patients in pathology department of mirza kochak khan hospital (Tehran, 2005- 2006). The smears were interpreted based on Bethesda system 2001.

Results: In conventional pap smear method, the number of occasions of unsatisfactory smear was 24(5%). In Liquid- based cytology method 66(22.8%) smears were unsatisfactory, In which difference between unsatisfactory groups were statistically significant (p<0.05), Also ASC diagnosis in conventional method 5(1.8%) as compared with Liquid- based cytology 6(2.1%), was not statistically significant (p>0.05).

Conclusions: There was no significant difference between two methods in term of ASC diagnosis but in conventional method adequacy of specimen was significantly better as compared with this Liquid- based cytology method.

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Background: Paranasal sinus disease is one of the most common problems of patients that refer to ENT centers. Adding to clinical examination imaging plays an important role in diagnosis and treatment. Also the imaging of paranasal sinuses is necessary before surgery. Although computed tomography is the modality of choice for these areas, it has some disadvantages which the most important one is its high patient's dose. The aim of this study is the comparison between cone beam volumetric tomography and conventional computed tomography computed tomography, in evaluation of these areas.

Methods: In this descriptive-analytic study Coronal computed tomography imaged and cone beam volumetric tomography images were performed for 40 patients referred to ENT department of Amir Aelam Hospital in Tehran, Iran. Computed tomography images were observed by general radiologist and cone beam volumetric tomography images by Maxillofacial radiologist and their results' were recorded. Also ENT surgeon recorded her observations during surgery. Data were analyzed using McNemar test with Kappa and weighted Kappa agreement coefficient.

Results: No statistical difference was shown between the efficacy of computed tomography and cone beam volumetric tomography in evaluation of paranasal sinuses (p> 0.05).

Conclusion: As there was not any difference between conventional computed tomography and cone beam volumetric tomography in the assessment of paranasal sinuses and additional advantages of the later, cone beam volumetric tomography is suggested for paranasal sinus imaging before surgery.

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Background: Autograft is the best option in nerve defects when end-to-end repair can not sufficiently preserve nerve continuity. Theoretically, if the severed nerve is reversely grafted, it may prevent axonal growth into nerve branches, and larger amounts of axons will reach the target organ and more satisfactory results will be obtained. In this study we aimed to compare conventional versus reverse nerve grafting.
Methods: This study was performed in Animal laboratory of Hazrat Fatemeh Hospital from April till August 2011. We randomly divided 40 Wistar rats into two groups. We excised 1.5 cm of the right sciatic nerve and anastomosed it conventionally between the proximal and distal ends of the nerve in rats in group A and in a reverse manner in rats in group B. The rats’ footprints were recorded in the first and 16th weeks after surgery. In week 16, the grafted nerves were removed under anesthesia for pathological examination and axon count. Subsequently, the results were compared clinically by sciatic functional index (SFI) through footprint analysis and paraclinically by axon count. A p-value smaller than 0.05 was considered statistically significant.
Results: Conventional and reverse nerve grafting no had statistically significant differences in clinical assessment in the first and 16th weeks (P=0.87) post-surgically and also no difference in paraclinical assessment in week 16 (P=0.68).
Conclusion: We had no significant clinically or para clinically differences between two approaches. It should be considered that the diameter and length of nerves and muscles in human is larger than rats, so the results of nerve repair may differ in human. We suggest a study in animal model which is anatomically more similar to human.

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Background: One of the most common infections in neonatal period is ophthalmia neo-natorum. In this study, the bacterial agents, drug resistance and susceptibility of bacteri-al agents were studied.
Methods: In this study a total of 72 newborns with ophthalmia neonatorum admitted in Bahrami Hospital in Tehran during the years 2008-2011 were continuously enrolled in a case series, descriptive study. Demographic data, including age, sex, cause of admis-sion and culture of discharge from the eyes and its antibiogram, as well as experimental treatments and treatment outcomes were collected.
Results: Forty four infants (61.1%) were males and 28 (38.9%) were females and the mean age on admission was 11.6±7.7 days. In 51 patients (70.8%) the onset of ophthal-mia neonatorum was prior to admission. More than 56% of cases with ophthalmia neonatorum were associated with sepsis. On the other hand, positive blood culture was detected in 15.3% of cases. Among 72 neonates with ophthalmia neonatorum, 26 (36.1%) had a positive culture of the eye discharge. The most common causes of bacterial agents were Staphylococcus aureus (46.1%) (12 of 26 cases). Other causes included streptococcus species (23%), Pseudomonas (15.3%), E-coli (11.5%) and Haemophilus influenza (3.8%). The most frequent causes of drug resistance were Ampicillin, Penici-llin, Cefixime, and Ceftazidime (100% resistance). The most sensiti-ve antibiotics were vancomycin and imipenem (100% sensitivity). Based on the conventional treatment, clinical response to local gentamicin was approximately 60%. Sulfacetamide was associated with no clinical response in 40% of cases.
Conclusion: The antibiogram and clinical response to empiric treatment showed that resistance to ampicillin and some third generation of cephalosporine was 100%. Aminoglycosides’ sensitivity was more than 50% locally and systemically. Our recommendation is performing eye discharge culture before antibiotic treatment. More studies with numerous cases should be done for better definition of bacterial resistance.

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Background: Respecting gestational age and medical intervention at birth, Combined Apgar score, a new method proposed by American Academy of Pediatrics (AAP) may better evaluate neonatal condition at birth compared with conventional Apgar score. The combined Apgar consists of the Specified and the Expanded Apgar describe a more detailed condition at birth. In Expanded Apgar, administered intervention and in Specified Apgar, infant`s condition regardelless of gestational age and intervention are emphesised. To evaluate combined Apgar score in perinatal asphyxia, we compared conventional versus Combined Apgar scores to anticipated neonatal asphyxial complications. Methods: In a prospective cohort study, we assessed 464 neonates admitted in, Vali-e-Asr University Hospital, during one year from September 2012 to September 2013. We assessed neonates by Conventional and Combined Apgar scoring at 1, 5 and 10 minutes after birth. Asphyxia was recognized based on newborn`s records. Diagnostic criteria for asphyxia include, occurrence of metabolic or mixed acidosis, apgar score less than three in 5th minute, occurrence of neurological complications like seizure, hypotonia, coma and multiple organ failure. Then we used SPSS V16 for data analysis and compare sensitivity between two methods of Apgar scoring. Results: From 2200 delivered neonates, we assessed 464 neonates. 9.3% of studied neonates had Asphyxia, which equals 2% of live births. The Apgar score was lower in asphyxiated neonates by both methods (6±1 vs. 9±1 according to conventional method and 9±1 vs. 16±1 scored in combined method). Combined method was more sensitive than the Conventional Apgar scoring (99% vs. 88%). Conclusion: In asphyxiated neonates sensitivity and specificity of combined apgar were more than conventional apgar. With respect to this study, better assessment could be achieved by combined apgar score method instead of conventional Apgar.