THE MODEL OF CLINICAL REASONING IN APPROACH TO FEBRILE INFECTIOUS DISEASES IN MEDIEVAL PERSIA

Reviewing ancient manuscripts of Persian medicine (PM) reveals that there have been some basic principles for decision-making in epidemic infectious diseases that existed in the past. These PM rules for clinical reasoning were applied through a personalized approach along with public health advice in such situations. Currently, the coronavirus pandemic has been the biggest problem in the world. Its mainstay of treatment is based on preventative measures and symptomatic treatments. Meanwhile, traditional medical systems for providing preventive, supportive, and rehabilitative care to patients have received more attention than before. Thus, the specific individual approach considered by PM scholars for clinical courses of epidemic infectious diseases may help shed more light on the spread of knowledge on epidemic diseases in ancient Persia.

Evaluation of platelet count, erythrocyte sedimentation rate and C-reactive protein levels in paediatric patients with inflammatory and infectious disease

Inflammatory and infectious diseases are the major causes of morbidity and mortality. The identification of markers for the assessment of disease activity and response to treatment can improve long-term prognosis. The aim of this study was to evaluate platelet count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) among children with inflammatory and infectious disease. This cross-sectional study was conducted in the paediatric immunology and infectious units of Shahid Madani Hospital of Khorramabad. One hundred fifty children, half boys and half girls, with diagnoses of infectious and inflammatory diseases were included in the study. Platelet count, ESR and CRP were measured at the time of hospitalization and thereafter (recovery phase). A questionnaire including demographic information, diagnosis and paraclinical data was completed. At the time of hospitalization, all 150 children had abnormal ESR, 110 (73.3%) had abnormal CRP and 12 (92%) had alterations in platelet count. At the time of discharge, one patient (0.7%) had normal ESR, 132 (88%) had normal CRP and 140 patients (93.3%) had normal platelet count. At the time of discharge, we found a significant difference between the levels of CRP and platelets in girls. This study showed that CRP level is useful during treatment follow-up. Changes in platelet count are likely to be more prevalent in girls.

P1055Reduction of radiation exposure using an optimized fluoroscopy protocol in cryoballoon ablation does not compromise clinical outcome

Background/Introduction

Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation is associated with an increased radiation exposure compared to radiofrequency ablation. Previous studies showed that radiation exposure in CB PVI can be reduced by optimizing the fluoroscopy protocol without comprising acute efficacy and safety.

Purpose

We evaluated the mid-term outcome of an optimized fluoroscopy protocol in patients undergoing CB PVI.

Methods

The study population comprised 90 consecutive patients who underwent second generation CB-based PVI. The first 46 patients underwent CB PVI with conventional fluoroscopy settings (Group A). In the following 44 patients (Group B) an optimized fluoroscopy protocol was applied consisting of 1) using fluoroscopy instead of filming for determining the pulmonary vein occlusion grade; and 2) optimal collimation of the area of interest. Primary endpoints were the total dose area product (DAP), fluoroscopy time and freedom from documented recurrence of atrial fibrillation (AF) after a single procedure.

Results

Group B had a lower median DAP (1393 cGycm2 vs. 3232 cGycm2, P < 0.001) and median fluoroscopy time (20 min vs. 24 min, P < 0.001) as compared to group A. The 1-year freedom from documented recurrence of AF after a single procedure was similar among groups (74% in Group A vs. 77% in Group B, P = 0.71). There were no significant differences between both groups for the secondary endpoints, including procedure duration, proportion of patients with complete electrical isolation, and complications.

Conclusion

Using an optimized fluoroscopy protocol in CB PVI radiation exposure could be reduced with a similar 1-year clinical outcome.

A Comparison between Clinical and Metabolic Features of Renal Calyceal Microlithiasis and Overt Urolithiasis in Different Pediatric Age Groups

INTRODUCTION

This study assesses the differences in the presentations, complications and metabolic abnormalities of children with renal calyceal microlithiasis (RCM) and overt urolithiasis in different pediatric ages.

MATERIALS AND METHODS

A total of 465 children with urolithiasis were investigated retrospectively. Patients were categorized based on their ages to infancy, early childhood, middle childhood and adolescence. When the hyperechogenic spots on ultrasound imaging were <3 mm, they were considered RCM, and if they were ≥3 mm, they were considered overt urolithiasis.

RESULTS

Metabolic abnormalities were detected in 71%; hyperuricosuria in infants, hyperoxaluria in younger children and hypocitraturia in older children were the most common metabolic abnormalities. Hypercalciuria was the only metabolic abnormality that was significantly associated with overt urolithiasis in all pediatric ages (OR 2.25, 95% CI 1.21-4.19). The clinical presentations were not significantly different between RCM and overt urolithiasis; however, complications such as urinary tract infection was significantly higher with overt urolithiasis in infancy (p = 0.01), early childhood (p = 0.02), middle childhood (p = 0.007) and adolescence (p = 0.01). Also, growth retardation was significantly higher with overt urolithiasis in infancy and early childhood (p = 0.02).

CONCLUSIONS

Most children with urolithiasis have underlying urinary metabolic abnormalities that differ according to the child's age. Despite these differences, hypercalciuria is significantly associated with overt urolithiasis in all pediatric ages. Clinical and laboratory features cannot differentiate RCM and overt urolithiasis; however, complications are significantly higher with overt urolithiasis.

Seroprevalence of Helicobacter pylori in Nahavand: a population-based study

In this cross-sectional study, we evaluated H. pylori seroprevalence and the relevant factors in 1518 people aged > or = 6 years from the general population of Nahavand, western Islamic Republic of Iran. Questionnaires covering sociodemographic variables were completed by interview. Blood samples were taken from each individual. Sera were tested for anti-H. pylori IgG using commercial enzyme immunoassay. Overall, seroprevalence of H. pylori was high, 71.0% (95% CI: 69.0%-73.0%). There was a gradual increase with age. Based on multivariate adjustment, only female sex and age could be considered risk factors.

The left gastric artery as an in-situ conduit in coronary artery bypass grafting

Unsuitability of the in-situ right gastroepiploic artery in coronary bypass grafting occurs. Sometimes free-grafting can be performed, although this should not be considered in patients with a diseased ascending aorta. We describe the successful use of the left gastric artery as an alternative in-situ arterial conduit in a patient with a severely atherosclerotic ascending aorta.

Neurite outgrowth of dorsal root ganglia is delayed and arrested by aspirin

In this study, the effect of increasing doses of aspirin on the neurite outgrowth of Dorsal Root Ganglia (DRG) was investigated. DRG were cultured in complete medium (DMEM + 10% FCS +100 ng/ml NGF + collagen Type1 in substratum in 96 multiwell plate) in the presence of concentration of 1.25, 2.5, 5 and 10 mM aspirin. The neurite outgrowth of DRG was followed in comparison with controls that lack aspirin. 10 mM aspirin treated DRG showed delayed neurite outgrowth and after 7 days it reached the same DRG neurite outgrowth control wells after 18 hrs. This growth has delayed approximately one week and showed no further development and in such stage the cells became apoptos. However at concentrations of 1.25, 2.5, 5 mM of aspirin, outgrowth was observed after 18-24 hrs. Although the rate of growth was lower than control, it was not significant. In the other experiment, when DRG cultured for one week in complete medium then treated with aspirin, at 10 mM, DRG neurite outgrowth was stopped, while it was continued in the control. It seem that the aspirin affected DRG became apoptosis.

Guillain-Barre syndrome and achalasia: two manifestations of a viral disease or coincidental association?

Guillain-Barre' syndrome and achalasia are rare diseases of uncertain cause. However, viral etiologies have been postulated for each disorder. The concomitant presence of both disorders in a patient suggests a common etiology, because a coincidental association would be exceedingly rare. Indeed, to our knowledge, the concomitant appearance of Guillain-Barre' syndrome and achalasia has not been previously reported. We now report our observation of a patient who developed dysphagia shortly after onset of Guillain-Barre' syndrome. Achalasia was subsequently diagnosed by manometry and was successfully treated by pneumatic dilation. The concomitant appearance of Guillain-Barre' syndrome and achalasia in our patient supports the notion of a viral etiology for achalasia.