Showing papers by "Shahid Beheshti University of Medical Sciences and Health Services published in 2007"

Object Category Structure in Response Patterns of Neuronal Population in Monkey Inferior Temporal Cortex

Abstract: Our mental representation of object categories is hierarchically organized, and our rapid and seemingly effortless categorization ability is crucial for our daily behavior. Here, we examine responses of a large number (>600) of neurons in monkey inferior temporal (IT) cortex with a large number (>1,000) of natural and artificial object images. During the recordings, the monkeys performed a passive fixation task. We found that the categorical structure of objects is represented by the pattern of activity distributed over the cell population. Animate and inanimate objects created distinguishable clusters in the population code. The global category of animate objects was divided into bodies, hands, and faces. Faces were divided into primate and nonprimate faces, and the primate-face group was divided into human and monkey faces. Bodies of human, birds, and four-limb animals clustered together, whereas lower animals such as fish, reptile, and insects made another cluster. Thus the cluster analysis showed that IT population responses reconstruct a large part of our intuitive category structure, including the global division into animate and inanimate objects, and further hierarchical subdivisions of animate objects. The representation of categories was distributed in several respects, e.g., the similarity of response patterns to stimuli within a category was maintained by both the cells that maximally responded to the category and the cells that responded weakly to the category. These results advance our understanding of the nature of the IT neural code, suggesting an inherently categorical representation that comprises a range of categories including the amply investigated face category.

Structured Clinical Interview for DSM-IV (SCID): Persian Translation and Cultural Adaptation

Abstract: The SCID was translated into Persian using an elaborate procedure to achieve a satisfactory cross-cultural equivalent. This included forward translation by bilingual (English/Persian) translators, discussion and revision of the translation in an expert panel of bilingual mental health professionals, pilot assessment on a small sample of Persian–speaking patients, back-translation into English and comparison with the original SCID. In addition, understandability and acceptability of the translated items were assessed in 299 patients in three psychiatric hospitals in Tehran, Iran.

OCT-4, an embryonic stem cell marker, is highly expressed in bladder cancer

Abstract: OCT-4 (also known as POU5F1) is a key regulator of self-renewal in embryonic stem cells. Regarding the new cancer stem cell concept, the expression of such genes is potentially correlated with tumorigenesis and can affect some aspects of tumor behavior, such as tumor recurrence or resistance to therapies. Although OCT-4 has been introduced as a molecular marker for germ cell tumors, little is known about its expression in somatic cancers. Here, we have investigated the potential expression of OCT-4 in bladder cancer. We used semiquantitative RT-PCR to examine the expression of OCT-4 in 32 tumors, 13 apparently nontumor tissues taken from the margin of tumors and 9 normal urothelial tissues. The expression of OCT-4 at protein level was further determined by Western blotting and immunohistochemical (IHC) analysis. OCT-4 expression was detected in almost all examined tumors (31/32), but at much lower level (p<0.001) in some nonneoplastic samples (6/22). A significantly strong correlation of 0.6 has been observed between OCT-4 expression and the presence of tumors (p<0.001). Western blot analysis further confirmed the expression of OCT-4 in tumor biopsies. According to IHC results, OCT-4 is primarily localized in the nuclei of tumor cells, with no or low immunoreactivity in nontumor cells. Our study demonstrated, for the first time, the expression of OCT-4 in bladder cancer and a further clue to the involvement of embryonic genes in carcinogenesis.

The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery.

Abstract: OBJECTIVE: Chronic subdura) hematoma (CSDH) is one of the most common types of intracranial hemorrhage, especially in the elderly, with a significant recurrence rate ranging from 9.2 to 26.5%, The role of postoperative patient posture in the recurrence of CSDH has not been studied sufficiently. METHODS: A total of 84 consecutive patients with unilateral traumatic CSDH without known risk factors of CSDH recurrence were prospectively enrolled in this study. All patients underwent burr-hole surgery with closed system drainage and were then allocated randomly to either of two groups: Group A (n = 42) patierifswere'keptin a supine position for 3 days after the operation, whereas Group B (n = 42) patients assumed sifting position in bed, with the head of the bed elevated to 30 to 40 degrees, for the same duration as Group A After 3 days, there was no restriction in patients' activities in both groups. All patients were followed-up for at least 3 months after surgery. bath RESULTS: The groups were not significantly different in age, sex, presence of brain atrophy or hydrocephalus, preoperative hematoma width, and postsurgery subdural space width. The recurrence rate in Groups A and B were 2.3 and 19.0% (necessitating repeat surgery in one patient), respectively (P = 0.02). Other complications in Groups A and B, respectively, were atelectasis (10 versus seven; P = 0.41), pneumonia (five versus four; P = 0.72), decubitus ulcer (three versus two; P = 0.64), and deep vein thrombosis (zero versus one; P = 0.31). CONCLUSION: Assuming an upright posture soon after burr-hole surgery was associated with a significantly increased incidence of CSDH recurrence but not with a significant change in other position-related postsurgical complications. According to this result, it is not recommended that elderly patients assume an upright posture soon after burr-hole surgery to prevent postoperative atelectasis and dementia, as these might significantly increase the risk of CSDH recurrence.

Pattern of acute poisoning in Tehran-Iran in 2003

Abstract: To characterize the poisoning cases admitted to the Loghman-Hakim Hospital Poison Center (a teaching reference hospital of poisoning) in Tehran, Iran. All admitted acutely poisoned patients from January to December 2003 were evaluated retrospectively. Information of socio-demographic characteristics, agents and cause of poisoning, and the mortality rate were collected from medical records of the hospital. During this period, 24 179 cases were referred to the emergency department that 10 206 of them were admitted. Of the admitted cases, 51% were male and 49% female. The majority (38%) of cases were in the age range of 21-30 years. Most (79%) of poisonings were intentional and 21% were unintentional. The most important agents of acute poisoning were drugs (69.13%) especially sedative-hypnotics followed by opioids (12.34%) and pesticides especially organophosphates (OPs) (6.21%). The mortality rate was 1.3% (318 patients). Death was mostly occurred by opioids (41.54%), followed by drugs (28%) and pesticides especially OPs (12%). The prevention and treatment of poisoning due to opioids, pesticides specially OPs and sedative-hypnotics drugs should merit high priority in the health care of the indigenous population of Tehran.

Sensitivity and specificity of confocal scan in the diagnosis of infectious keratitis.

Abstract: Purpose:To compare the sensitivity and specificity of confocal scan with the results of corneal and/or contact lens case smear and culture in the diagnosis of infectious keratitis.Methods:This was a diagnostic test study. Confocal scan and corneal and/or contact lens case smear and culture were perf

A radiographic analysis of external apical root resorption of maxillary incisors during active orthodontic treatment.

Abstract: External apical root resorption (EARR) is an undesirable consequence of orthodontic treatment. The purpose of this study was to measure the amount of EARR and to examine its clinical significance in maxillary incisors, during a 12-month active treatment period. A further aim was to examine the contribution of gender, treatment technique, treatment duration, and extraction of maxillary first premolars to EARR. The sample comprised 151 maxillary incisor teeth in 40 patients (16 males, 24 females) aged 12-22 years, with different malocclusions. Standard periapical radiographs, using the long-cone paralleling technique, were obtained before and 6 and 12 months after the start of treatment. Quantitative measurements for 80 central and 71 lateral maxillary incisors were performed separately and corrected for image distortion. Root length reduction was calculated in millimetres and in terms of the percentage of the original root length. Resorption of more than 1 mm at 12 months of active treatment was considered to be clinically significant. On average, the degree of EARR for the maxillary central incisors was 0.77 +/- 0.42 and 1.67 +/- 0.64 mm, respectively, during the 6- and 12-month follow-up (P < 0.001). For the lateral incisors, the degree of EARR was 0.88 +/- 0.51 and 1.79 +/- 0.66 mm, respectively (P < 0.001). Clinically significant resorption was found for 74 per cent of the centrals and 82 per cent of the laterals. No significant correlation was observed between EARR and treatment technique. EARR was found to be correlated with gender for the lateral incisors. The effect of treatment duration (P < 0.001) and premolar extraction (P < 0.001) was statistically significant for both tooth groups.

The relationship between depression and serum ferritin level

Abstract: This study looks at the association of depression and serum ferritin level. Case–control study. University hospital. Two hundred and five female medical students of Free University of Medical Sciences in Tehran were selected for the study (mean age; 24.5±1.6 years). Of these, 13 subjects were excluded and finally 192 subjects took part in the study. A questionnaire was filled in by each participant for the diagnosis of depression to be made. Based on the Beck score, the students were grouped as depressed and healthy (67 depressed students and 125 healthy controls). The participants were evaluated in terms of hemoglobin (Hgb) level, serum ferritin, ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), folic acid, vitamin B12 and Hgb simultaneously. The prevalence of depression in the study population was 34.7%. The mean ferritin level in students with depression was significantly lower than the healthy ones (P<0.001). By changing the status from normal ferritin level to low ferritin level, odds of depression was increased by 1.92 (P<0.05). The study implies a possible association between depression and decreased ferritin level before the occurrence of anemia. Free University of Medical Sciences.

Peripheral and central giant cell granulomas of the jaws: a demographic study.

Abstract: Objective This study aimed to assess the demographic characteristics of peripheral giant cell granulomas (PGCGs) and central giant cell granulomas (CGCGs) in patients treated at our centers. Study design This 12-year retrospective study was based on existing data. Files of patients from 1993-2004 with a definite diagnosis of PGCGs and CGCGs from the oral pathology departments of our universities were assessed. Information regarding age distribution, gender, the jaw involved, the presenting area of the lesion, surgical treatment, and recurrence was documented. Results During the study period, 204 patients with CGCGs were treated. The patients with CGCGs varied in age from 5 to 72 years, and the mean age patients was 23.72 years. Among these, 127 cases (62.87%) occurred in the second and third decades of life. One hundred thirty cases (63.75%) occurred in females and 74 (36.25%) in males. Ninety cases (44.1%) presented in posterior parts of the jaws. One hundred forty-four cases (70.58%) appeared in the mandible. Peripheral GCGs presented in 575 patients, who varied in age from 2 to 85 years with a mean age of 31.02 years. Among these, 297 cases (51.65%) occurred in females and 278 (48.34%) in males. Four hundred sixty-seven cases (81.2%) occurred in the first five decades of life, and 352 cases (61.21%) appeared in the mandible. Conclusions Giant cell granulomas comprised 9.29% of oral lesions. Peripheral GCG lesions occurred more than 2 times more frequently than CGCGs. Central GCGs occurred about 2 times more frequently in females, whereas PGCGs had an equal prevalence in both genders ( P P P P P

Crimean-Congo hemorrhagic fever.

Abstract: Crimean-Congo hemorrhagic fever is a tick-borne viral disease reported from more than 30 countries in Africa, Asia, South-East Europe, and the Middle East. The majority of human cases are workers in livestock industry, agriculture, slaughterhouses, and veterinary practice. Nosocomial transmission is also well described. Clinical manifestations are nonspecific and symptoms typically include high fever, headache, malaise, arthralgia, myalgia, nausea, abdominal pain, and nonbloody diarrhea. Patients may show signs of progressive hemorrhagic diathesis. Laboratory abnormalities may include anemia, leukopenia, thrombocytopenia, increased AST/ALT levels, and prolonged prothrombin, bleeding, and activated partial thromboplastin times. Diagnostic methods include antibody detection by enzyme-linked immunosorbent assay, virus isolation, antigen detection, and polymerase chain reaction. The mainstay of treatment of Crimean-Congo hemorrhagic fever is supportive, with careful maintenance of fluid and electrolyte balance, circulatory volume, and blood pressure. The Crimean-Congo hemorrhagic fever virus is susceptible to ribavirin in vitro. There is no controlled study evaluating oral versus intravenous ribavirin in treating Crimean-Congo hemorrhagic fever patients, but few studies have evaluated oral ribavirin. This article reviews the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, prevention, and prognosis of Crimean-Congo hemorrhagic fever with a special focus on oral ribavirin as a choice of medical treatment.

Intravitreal bevacizumab (Avastin) injection for neovascular glaucoma.

Abstract: Neovascular glaucoma is a secondary glaucoma with grave prognosis which follows ischemic retinal disorders in the majority of cases. Mediators that induce new vessel formation such as the vascular endothelial growth factor-A seem to play a key role in the pathophysiology of this condition. Herein, we report 2 cases with neovascular glaucoma secondary to ischemic central retinal vein occlusion who received treatment with intravitreal bevacizumab (Avastin) a nonselective antibody against vascular endothelial growth factor-A. Both patients demonstrated dramatic short-term response in terms of intraocular pressure reduction and regression of neovascularization.

Outcomes and recurrence rates in chronic subdural haematoma

Abstract: The object of this study was to determine the relationship between outcome (assessed by Glasgow Outcome Scale) and recurrence in chronic subdural haematoma (CSDH). Eighty-two consecutive patients w...

Computational modelling of the flow of viscous fluids in carbon nanotubes

Abstract: Carbon nanotubes will have extensive application in all areas of nano-technology, and in particular in the field of nano-fluidics, wherein they can be used for molecular separation, nano-scale filtering and as nano-pipes for conveying fluids. In the field of nano-medicine, nanotubes can be functionalized with various types of receptors to act as bio-sensors for the detection and elimination of cancer cells, or be used as bypasses and even neural connections. Modelling fluid flow inside nanotubes is a very challenging problem, since there is a complex interplay between the motion of the fluid and the stability of the walls. A critical issue in the design of nano-fluidic devices is the induced vibration of the walls, due to the fluid flow, which can promote structural instability. It has been established that the resonant frequencies depend on the flow velocity. We have studied, for the first time, the flow of viscous fluids through multi-walled carbon nanotubes, using the Euler–Bernoulli classical beam theory to model the nanotube as a continuum structure. Our aim has been to compute the effect of the fluid flow on the structural stability of the nanotubes, without having to consider the details of the fluid–walls interaction. The variations of the resonant frequencies with the flow velocity are obtained for both unembedded nanotubes, and when they are embedded in an elastic medium. It is found that a nanotube conveying a viscous fluid is more stable against vibration-induced buckling than a nanotube conveying a non-viscous fluid, and that the aspect ratio plays the same role in both cases.

Indications for penetrating keratoplasty in Iran.

Abstract: PURPOSE To determine the indications for penetrating keratoplasty (PK) in Iran. METHODS : All eye bank records of patients who had undergone PK between 1994 and 2004 at ophthalmic centers throughout the country were reviewed. RESULTS During this 11-year period, a total of 19,668 cases were operated on. The most common indication for PK was keratoconus (n = 6787, 34.51%), followed by corneal opacity and scar (n = 3674, 18.68%), pseudophakic bullous keratopathy (n = 1808, 9.19%), corneal dystrophies (n = 1272, 6.47%), aphakic bullous keratopathy (n = 1198, 6.09%), and regraft (n = 1038, 5.28%). There was an increasing trend in rates of keratoconus and pseudophakic bullous keratopathy and a decreasing trend in aphakic bullous keratopathy over this period (P < 0.001). No significant change of trend was noted in the corneal opacity and scar, regraft, and corneal dystrophy groups. CONCLUSIONS Keratoconus is the most common indication for PK in Iran.

Protective Effects of α-Tocopherol and N-Acetyl-Cysteine on Diazinon-Induced Oxidative Stress and Acetylcholinesterase Inhibition in Rats

Abstract: Diazinon, an organophosphate (OP) insecticide, is widely used in agriculture and domestically. Reactive oxygen species (ROS) caused by OPs are involved in the toxicity of various pesticides. The aim of the present study was to analyze the role of diazinon in inducing oxidative stress in adult male Wistar rats and to evaluate the possible protective effects of α-tocopherol (TPH) and the glutathione prodrug N-acetyl-cysteine (NAC) after 4 weeks of exposure to a sublethal dose of diazinon. TPH (10 mg/kg/day), NAC (160 mg/kg/day), diazinon (25 mg/kg/day), a combination of NAC (160 mg/kg/day) and diazinon (25 mg/kg/day), and a combination of TPH (10 mg/kg/day) and diazinon (25 mg/kg/day) were given to rats orally via gavage for 4 weeks. The thiobarbituric acid reactive substances (TBARS) marker of lipid peroxides levels, total thiol molecules, and total antioxidant capacity of plasma were all analyzed as biomarkers of oxidative stress. In addition, the acetylcholinesterase (AChE) activity was measured as a biomarker of toxicity. The results from this study well indicate diazinon-induced oxidative stress demonstrated by enhanced TBARS, decreased total thiol molecules, and total antioxidant capacity. In addition, AChE activity was inhibited as a marker of OP toxicity. Data show the protective roles of TPH and NAC in reducing the diazinon-induced oxidative stress. Interestingly, both TPH and NAC recovered diazinon-induced AChE inhibition. It is concluded that supplementation with TPH and NAC can reduce toxicity of OP in human exposure.

Culture of human gingival fibroblasts on a biodegradable scaffold and evaluation of its effect on attached gingiva : A randomized, controlled pilot study

Abstract: Background: An adequate width of attached gingiva is necessary to maintain healthy periodontium, especially in orthodontics or restorative treatments in periodontics. The purpose of this study was to evaluate the width of attached gingiva after clinical application of a cultured gingival graft compared to a periosteal fenestration technique.Methods: This study was conducted on nine patients (18 sites) with insufficient attached gingiva adjacent to at least two teeth in contralateral quadrants of the same jaw. A small portion (∼3 × 2 × 1 mm) of attached gingiva (epithelial + connective tissue) was removed with a surgical blade. After culture of gingival fibroblasts, 2 × 105 cells in 250 μl nutritional medium were added to 250 μl collagen gel. One tooth in each patient was randomized to receive a periosteal fenestration technique for gingival augmentation (control) or a tissue-engineered mucosal graft (test). Clinical parameters measured at baseline and 3 months included width of keratinized tissue, probing...

Evaluation of antimicrobial effect of MTA, calcium hydroxide, and CEM cement.

Abstract: INTRODUCTION: The antibacterial effects of calcium hydroxide (CH), mineral trioxide aggregate (MTA), and calcium enriched mixture (CEM) cement against various spp. of microorganisms were assessed in-vitro using agar diffusion test. MATERIALS AND METHODS: A base layer of Petri plates was made using Muller-Hinton agar. Four cavities were made in agar and filled with freshly mixed materials after 24 h. The microorganisms were seeded by pour plate. The plates were pre-incubated for 2 h at room temperature followed by incubation at 37˚C for 24 h. The inhibition zones diameters were measured by an independent observer. RESULTS: The highest mean diameters of growth inhibition zones were founded around CH and CEM cement. According to One-way ANOVA there was a significant difference among test groups (p<0.001); Post Hoc test revealed no significant difference between the mean zones diameter of CH and CEM cement. However, there was significant difference among CH and CEM cement in comparison with MTA group (p<0.001). CONCLUSION: It appears that CEM cement is a potent antibacterial agent like CH.

Effects of Water on Enzyme Performance with an Emphasis on the Reactions in Supercritical Fluids

Abstract: Enzymes require a certain level of water in their structures in order to maintain their natural conformation, allowing them to deliver their full functionality. Furthermore, as a modifier of the solvent, up to a certain level, water can modify the solvent properties such as polarity/polarizability as well as the solubility of the reactants and the products. In addition, depending on the type of the reaction, water can be a substrate (e.g., in hydrolysis) or a product (e.g., in esterolysis) of the enzymatic reaction, influencing the enzyme turnover in different ways. It is found that regardless of the type of reaction, the functionality of enzyme itself is maximum at an optimum level of water, beyond which the enzyme performance is declined due to the loss in enzyme stability. Furthermore, mass transfer limitations caused by pathway blockage and/or by reduced solubilities of the reactants and/or products can also affect the enzyme performance at higher water levels. Controlling water content of ingoing CO2 and substrates as well as precise management of enzyme support and salt hydrates are important strategies to adjust water level in reaction media, especially in supercritical environments.

Oral health behaviour and its determinants amongst Iranian dental students

Abstract: Objectives: To study the oral health behaviour (OHB) of Iranian senior dental students in relation to their gender, background characteristics, knowledge of preventive care, and attitudes towards preventive dentistry. Materials and methods: Using a cluster random sampling approach, a questionnaire survey was conducted with 327 senior dental students in seven dental schools. The questionnaire covered age, gender, parents’ employment in dentistry, previous academic education in dental hygiene, oral self-care, most recent dental check-up, knowledge of preventive dentistry and attitudes towards it. Attending a dental check-up by a dentist or a classmate within the last year was defined as preventive care use. Chi-square test and logistic regression models were used for statistical analyses. Results: Women reported significantly higher frequencies of tooth brushing (P < 0.001), fluoridated toothpaste use (P = 0.001) and flossing (P < 0.001) compared with men. Respondents who had been previously educated as dental hygienists had lower frequencies of eating sugary snacks (P < 0.001) and paid more attention to preventive care (P = 0.03) than others. Those with more extensive knowledge of preventive care reported higher frequencies of using fluoridated toothpaste (P = 0.05). Reported frequencies of brushing were higher amongst those with more positive attitudes (P = 0.03). In logistic regression models, having at least one parent employed as a dentist was significantly associated with higher frequencies of eating sugary snacks (P = 0.047, OR = 0.3) and more frequent preventive care use (P = 0.048, OR = 2.9). Conclusion: Education and training in preventive measures should be effective enough to overcome background characteristics. There is room for improving the OHB of Iranian dental students.

Assessment of management and treatment responses in haemodialysis patients from Tehran province, Iran

Abstract: Background. Chronic kidney disease (CKD) and endstage renal disease (ESRD) are emerging as globally important public health problems, and will necessitate improvements in health-care policy. ESRD incidence/ prevalence data are not available from large parts of the developing world. The main objective of this study is to describe and assess the current clinical practices for patients on maintenance haemodialysis (HD) living in the province of Tehran. Methods. In December 2005, an observational study was performed with 2630 patients (1505 males and 1125 females) from 56 different centres in the province of Tehran (the entire HD population), which has a population of 13.5 million inhabitants. Results. The prevalence/incidence of HD was 194.8/ 77.3 p.m.p. The leading causes of ESRD were diabetes and hypertension. Population of 90.3 and 9% received three and two sessions per week, respectively, with a KT/V mean value of 0.97 0.25. All centres used synthetic membranes, and 68% of the sessions were performed using bicarbonate as a buffer. The type of vascular access was autogenous arteriovenous fistula in 91% of patients. Our findings indicated that compliance with the K/DOQI recommendations for calcium–phosphorus management is difficult to achieve. Only 1.8% of patients achieved all four target laboratory tests. For the management of anaemia, ferritin was the most commonly performed measure of iron status (76.7%). Iron deficiency was seen in <20% of patients (ferritin 200) and the mean value of haemoglobin (Hb) was 10.14 2.00 g/dl. Conclusion. The achieved standard of renal replacement therapy (RRT) in Tehran province, Iran is acceptable and in some aspects is comparable with European countries, but the number of ESRD patients is increasing in Tehran and worldwide. Increases in the number of HD centres, machines, shifts and kidney transplantations are taking place but cannot keep pace with the increasing number of patients. It is highly recommended that we try to increase peritoneal dialysis (PD) coverage and cadaveric transplantation, while keeping in mind that the prevalent population of individuals with CKD is estimated to be at least 20 times the number with ESRD. It is not too ambitious to consider CKD prevention, and we should place initial focus on strategies and treatments that slow disease progression, in order to postpone RRT.

Diagnostic Performance of 64-Channel Multislice Computed Tomography in Assessment of Significant Coronary Artery Disease in Symptomatic Subjects

Abstract: The recent development of 64-channel multislice computed tomography (MSCT) has resulted in noninvasive coronary artery imaging improvement. This study was conducted to determine the accuracy of 64-slice MSCT in a relatively unselected group of 143 patients with presentations suggestive of coronary artery disease, including those with unstable angina pectoris, who underwent both coronary computed tomographic angiography and invasive coronary angiography. No arrhythmia was considered an exclusion criterion except for atrial fibrillation or frequent extrasystoles. In patients with fast heart rates, a beta blocker was administered orally. Data were obtained using electrocardiography gated 64-slice MSCT. Computed tomographic angiography and invasive coronary angiography findings of each coronary segment were compared to determine the sensitivity, specificity, positive predictive value, and negative predictive value of MSCT in the detection of their normalcy or insignificant ( or=50% diameter decrease) stenosis or total occlusion. In per-patient assessment, the calculated sensitivity, specificity, positive predictive value, and negative predictive value of MSCT were 96%, 67%, 91%, and 83%, respectively. These values in per-artery evaluation were 94%, 94%, 87%, and 97%, and corresponding values in per-segment analysis were 92%, 97%, 77%, and 99%, respectively. In conclusion, computed tomographic angiography has high diagnostic performance in the assessment of significant coronary artery disease in most patients in a daily routine practice, including those presenting with unstable angina pectoris symptoms.

Ceftriaxone associated nephrolithiasis: a prospective study in 284 children

Abstract: Urinary tract calculi have been reported to account for between 1 in 1,000 and 1 in 7,600 hospital admissions in children in the USA. The annual incidence of urolithiasis in patients older than 10 years is 109 per 100,000 of the population in men and 36 per 100,000 of the population in women in Minnesota. The use of various medications is considered to be one of the etiologic factors of nephrolithiasis. Ceftriaxone is a widely used third-generation cephalosporin that is generally considered very safe, but complications such as biliary pseudolithiasis, and rarely, nephrolithiasis have been reported in children. There is limited information about urolithiasis as a side effect of ceftriaxone. The aim of this study was evaluation of the incidence of nephrolithiasis following ceftriaxone therapy in children. This quasi-experimental before and after study was conducted in Mofid Children’s Hospital between 2003 and 2005. All patients were treated with 75 mg/kg intravenous ceftriaxone. Diagnosis of pyelonephritis was based on standard criteria. The first renal ultrasonography was performed on the first or second day of admission and was repeated on the last day of treatment. We also evaluated complicated patients for the third time with renal ultrasonography 3 months after treatment. Stone-forming patients underwent metabolic kidney stone risk factor evaluation. We evaluated 284 patients with pyelonephritis, 185 girls and 99 boys. The first ultrasonography was normal in all of our patients. On the second ultrasonography renal stones were reported in 4 out of 284 cases (1.4% and CI = 0.96–1.83%). Underlying metabolic risk factors could not be identified in stone-forming patients. Follow-up ultrasonography 3 months later was normal. The results of our study suggest that ceftriaxone-treated patients may be at an increased risk of kidney stone formation. Stones passed spontaneously in all affected patients so the use of this effective drug can be safely continued. Close monitoring of ceftriaxone-treated patients with regard to kidney stone formation is recommended.