Passive smoking and nasopharyngeal colonization by <Emphasis Type="Italic">Streptococcus pneumoniae</Emphasis>, <Emphasis Type="Italic">Haemophilus influenzae</Emphasis>, and <Emphasis Type="Italic">Moraxella catarrhalis</Emphasis> in daycare children

Exposure to tobacco smoke may be associated with higher risk of nasopharyngeal colonization and infection by Streptococcus pneumoniae (SP), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC). This study was done to determine the influence of passive smoking on S. pneumoniae, H. influenzae, and M. catarrhalis colonization rates among children. This is a prospective cross-sectional study. Tertiary referral centers with accredited otorhinolaryngology-head and neck surgery and Microbiology Departments. In this cross-sectional study, 2–6 years old children in 10 randomly selected day-care centers in northeast of Iran (Mashad) were studied. Smoking exposure and medical history were recorded. Carriage rates for aforementioned bacteria were analyzed on the basis of smoking exposure. 1,125 children (Female/Male: 597/528) with the mean age of 5.05 ± 0.98 years were studied. Carriage rates of S. pneumoniae, H. influenzae and M. catarrhalis among children were 10.1, 8.8 and 6.7%, respectively. Mixed colonization was found in 2.7%. There was a significant difference in carriage rates between children who live in smoking families compare to those with nonsmoking families for M. catarrhalis (P = 0.001) but not for S. pneumoniae, and H. influenza (P = 0.798 and P = 0.117, respectively). It seems exposure to tobacco smoke is associated with increased carriage rate of M. catarrhalis in day-care children.     

Monitoring of serum vancomycin concentrations in pediatric patients with normal renal function

Vancomycin is a a glycopeptide antibiotic with bacetiocidal effects on gram positive bacteria by interfering with cell wall synthesis. The necessity for monitoring of serum vancomycin concentrations (SVCs) has been recently noticed at many institutions because of concerns for its nephrotoxicity. We aimed to describe the SVCs monitoring in pediatric patients, in an effort to determine subtherapeutic or toxic levels. The medical records were reviewed for all patients older than 60 days of age admitted to the general or subspecialty services who received intravenous vancomycin at Children's Medical Hospital in Tehran, Iran between July 2003 and December 2005. Because pharmacokinetic parameters for children with cancer may be different, this group was evaluated separately. During the study, 167 infants and children without cancer and 42 patients with cancer; aged between 3 months to 17.5 years were treated with vancomycin for various infections. In children without cancer, peak SVCs were in an adequate therapeutic range for 93% of patients (8-55 microg/ml). For children with cancer, peak SVCs was lower than 10 microg/ml (10%), and trough values were lower than 5 microg/ml (21%). In conclusion, according to the results of this research, due to different pharmacokinetics of vancomycin in cancerous patients, the monitoring of vancomycin plasma concentrations is necessary for the best therapeutic antibacterial activities with a fewer occurrence of serious adverse effects.     

A Misdiagnosis Led to an Extensive Skull Base Surgery: Infratemporal Tuberculosis Mimicking Giant Cell Tumor

Tuberculosis is a major health problem in developing countries. Tuberculosis of the infratemporal region is not common and the diagnosis could be complicated because of the similarity of the presentation to neoplasm. In our paper, we report a 49 year old male presented with a preauricular mass with extension to parotid in right side of the face. The primary histologic diagnosis was giant cell tumor with bony involvement and radical surgery was taken. After 16 months the patient was developed recurrence of the primary lesion in association with post auricular fistula. Ultimately, infratemporal tuberculosis was diagnosed according to result of the drained discharge by AFB microscopy. Therefore, tuberculosis should be considered as an important differential diagnosis of mass lesions in head and neck area, even when there is no history of significant exposure and no systemic signs or symptoms of tuberculosis.     

Bilirubin/Albumin Ratio for Predicting Acute Bilirubin-induced Neurologic Dysfunction

Objective

The aim of this study was to evaluate the bilirubin albumin (B/A) ratio in comparison with total serum bilirubin (TSB) for predicting acute bilirubin-induced neurologic dysfunction (BIND).

Methods

Fifty two term and near term neonates requiring phototherapy and exchange transfusion for severe hyperbilirubinemia in Children''s Medical Center, Tehran, Iran, during September 2007 to September 2008, were evaluated. Serum albumin and bilirubin were measured at admission. All neonates were evaluated for acute BIND based on clinical findings.

Findings

Acute BIND developed in 5 (3.8%) neonates. B/A ratio in patients with BIND was significantly higher than in patients without BIND (P<0.001). Receiver operation characteristics (ROC) analysis identified a TSB cut off value of 25 mg/dL [area under the curve (AUC) 0.945] with a sensitivity of 100% and specificity of 85%. Also, according to the ROC curve, B/A ratio cut off value for predicting acute BIND was 8 (bil mg/al g) (AUC 0.957) with sensitivity of 100% and specificity of 94%.

Conclusion

Based on our results, we suggest using B/A ratio in conjunction with TSB. This can improve the specificity and prevent unnecessary invasive therapy such as exchange transfusion in icteric neonates.     

Biotyping, capsular typing, and antibiotic resistance pattern of Haemophilus influenzae strains in Iran

The aim of this study was to determine the capsular types of Haemophilus influenzae isolated from clinical specimens by slide agglutination serotyping (SAST) and PCR capsule typing methods. All the isolates were biotyped and their antibiotic resistance patterns also determined. Thirteen isolates of serotype b, 2 of serotype e, 4 of serotype f, and 19 nontypeable (NT) isolates were identified by SAST method in 38 H. influenzae culture-positive samples. Capsule typing by PCR increased the proportion of all invasive cases from 34.2% (by SAST) to 60.5%, and 6 culture-negative samples were identified as invasive H. influenzae (Hib) by this method. The discrepancy rate between SAST and PCR results were 41%. Biotypes I, II, and III were the prevalent biotypes whereas biotypes VI and VII were not found. The majority of capsule type b belonged to biotype II. The isolates were resistant to cotrimoxazole (47.1%) and ampicillin (43.6%). Multidrug resistance was observed in 7 of the isolates.     

Fabrication of a PVDF membrane with tailored morphology and properties via exploring and computing its ternary phase diagram for wastewater treatment and gas separation applications

We report a simple approach for tailoring the morphology of poly(vinylidene fluoride) (PVDF) membranes fabricated using a nonsolvent induced phase separation (NIPS) method that sustains both the hydrophilic and hydrophobic properties. Various membrane structures, i.e. skin layers and whole membrane structures as well, were obtained via an experimental method based on the obtained and computed ternary phase diagram. The nonsolvent interactions with polymer solution resulted in the different forms and properties of a surface layer of fabricated membranes that affected the overall transport of solvent and nonsolvent molecules inside and outside the bulk of the fabricated membranes. The resulting morphology and properties were confirmed using the 3D optical profiler, SEM, FT-IR and XRD methods. The effect of binary interaction parameters on the morphology of the fabricated membranes and on their separation performance was tested using water/oil mixture and gas separation. Both hydrophobic and hydrophilic properties of PVDF showed the excellent durable separation performance of the prepared membranes with 92% of oil separation and the maximum flux of 395 L h⁻¹ m⁻² along with 120 min of long-term stability. CO₂ separation from H₂, N₂, CH₄ and SF₆ gases was performed to further support the effect of tuned PVDF membranes with different micro/nanostructured morphologies. The gas performance demonstrated ultrahigh permeability and a several-fold greater than the Knudsen separation factor. The results demonstrate a facile and inexpensive approach can be successfully applied for the tailoring of the PVDF membranes to predict and design the resulting membrane structure.

We report a simple approach for tailoring the morphology of poly(vinylidene fluoride) (PVDF) membranes fabricated using a nonsolvent induced phase separation (NIPS) method that sustains both the hydrophilic and hydrophobic properties.     

Impact of Hepatitis C Virus Infection on Cognitive Function in Patients With Covert Hepatic Encephalopathy

Background:

Liver cirrhosis has a significant impact on patient’s quality of life and socioeconomic status and is associated with increased susceptibility to vehicle accidents and falls.

Objectives:

This study was conducted to evaluate cognitive function in patients with cirrhosis.

Patients and Methods:

All subjects, who underwent transient elastography (TE) between March 2014 and August 2014 in Shariati outpatient clinic, Tehran, Iran, were enrolled in the study. The diagnosis of cirrhosis was made based on clinical and laboratory findings and liver stiffness measurement (LSM) values > 14. Wechsler Memory Scale (WMS) and simple visual reaction time (RT) were the neuropsychiatric tests used to assess cognitive function, in all subjects.

Results:

A total of 37 cirrhotic patients and 37 matched controls were included. Patients with cirrhosis had significantly lower mean quotient (MQ) score, compared with controls (91 ± 18.2 vs. 114.6 ± 17.5, P <0.001). All of WMS subscales, except associate learning, showed statistically significant differences between the two groups. Reaction time was more prolonged in patients with cirrhosis, compared with controls. Cognitive function of hepatitis C virus (HCV) patients was significantly impaired, with respect to logical memory, visual reproduction and MQ score, compared to other underlying causes of cirrhosis (P = 0.01, P = 0.04, and P = 0.01, respectively)

Conclusions:

Our results suggested that neuropsychiatric and cognitive problems must be considered in the management of covert hepatic encephalopathy (HE) patients, especially in patients with HCV infection. The WMS and simple visual RT tests are useful methods for the early diagnosis of covert HE.     

Evaluation of procalcitonin and neopterin level in serum of patients with acute bacterial infection

BackgroundFever as a common presenting complaint in pediatric patients can be due to various causes. Differentiating bacterial infection from other causes is important because the prompt use of antibiotics is critical in bacterial infection. Traditional markers of infection such as BT and WBC count may be unspecific and culture may be late or absent. CRP and Procalcitonin (PCT) have been considered to evaluate the evolution of infections and sepsis in patients presenting with SIRS. Neopterin has also been proposed to aid in the diagnosis of bacterial infection. In this study, we compared the value of the serum PCT, neopterin level, and WBC count for predicting bacterial infection and outcome in children with fever.Methods158 pediatric (2-120-month-old) patients suspected to have acute bacterial infection, based on clinical judgment in which other causes of SIRS were ruled out were included in the study. WBC count with differential was determined and PCT and neopterin levels were measured.ResultsPCT level was higher in bacterial infection and patients who were complicated or expired.ConclusionRapid PCT test is superior to neopterin and WBC count for anticipating bacterial infection, especially in ED where prompt decision making is critical. Abbreviations: BT, body temperature; WBC, white blood cell; PCT, procalcitonin; CRP, C-reactive protein; SIRS, systemic inflammatory response syndrome; ED, emergency department.     

Transoesophageal needle aspiration using a convex probe ultrasonic bronchoscope

Background and objective:   Although endoscopic ultrasound-guided fine needle aspiration can be helpful when combined with bronchoscopic procedures, endoscopic ultrasound-guided fine needle aspiration is not available as a conjunctive procedure with bronchoscopy at many institutions. This study evaluated the feasibility and the additional role of transoesophageal fine needle aspiration using a convex probe ultrasonic bronchoscope (EUS-B-FNA).
Methods:   We analysed 84 patients who underwent EUS-B-FNA between Oct 2007 and May 2008. Bronchoscopy and/or endobronchial ultrasound-guided transbronchial needle aspiration was performed on 83 patients prior to EUS-B-FNA.
Results:   EUS-B-FNA was performed on 89 lesions (1.7 aspirations/lesion) including three lung masses and 86 lymph nodes (nodal stations 1, 3P, 4L, 5, 7, 8, 9 and 10L) without complication. Sample adequacy was 95.4% for each aspiration and 100% for each lesion. Of the 89 lesions, 39 malignant lesions were confirmed by EUS-B-FNA. EUS-B-FNA provided additional diagnostic gain to bronchoscopic procedures in 16 patients (19.0%): 3 lung cancers were upstaged, 11 lung cancers were pathologically confirmed, and 2 patients were diagnosed with mediastinal metastasis from an extrathoracic malignancy. This gain was obtained by the sampling of inaccessible ( n  = 4) or difficult lesions by endobronchial ultrasound-guided transbronchial needle aspiration ( n  = 2) or when bronchoscopy was difficult due to dyspnoea, cough, brain metastasis or other conditions ( n  = 10).
Conclusions:   EUS-B-FNA is a technically feasible and safe procedure, which may be an alternative to endoscopic ultrasound-guided fine needle aspiration as a procedure that complements bronchoscopy. Additional diagnostic yield can be obtained by combining EUS-B-FNA with bronchoscopic procedures.