Caspian Journal of Internal Medicine
Volume:3 Issue: 2, Spring 2012

Since the introduction of the first radioimmunoassay, several improvements have been made in the design of immunoassays such as method of antibody production, labeling, automation and detection technology. We performed an analytical evaluation of the new electrochemiluminescent immunoassay (ECLIA) for serum TSH, FT4 and T3 in the Elecsys 2010 immunoassay system and compared the results of this method with those of radioimmunoassay (RIA) [immunoradiometric (IRMA) for TSH] and Elisa. Fasting serum from 112 hypo, hyper and euthyroid patients were used to evaluate the minimum detectable concentration, intra- and inter-assay precisions for TSH, FT4, T3, linearity for TSH assay and method comparison study. Within the analytical range tested, intra-assay coefficient of variation was < 2.3% for TSH, 2.3% for FT4 and 7.8% for T3. The inter-assay coefficient of variation was < 2.9% for TSH, 2.5% for FT4 and 12.3% for T3. The measurement of diluted sera indicated a desirable percentage of recovery for TSH. No correlation was found between Elecsys 2010 and Elisa /IRMA for TSH. The comparison of results of the Elecsys ECLIA assay with those of Elisa and RIA for T4 were: T4 (ECLIA) = -0.612+0.999, T4 (Elisa, r= 0.88) and T4 (ECLIA)=0.642+0.942 T4 (RIA, r=0.957), while ECLIA assay with Elisa and RIA for T3 were: T3 (ECLIA)= 0.242+0.908 T3 (Elisa, r=0.8) and T3 (ECLIA) = -0.029+1.01 T3 (RIA, r=0.957). The results show that Elecsys 2010 is an automated reliable, efficient and technically excellent instrument to use in the measurement of serum TSH, T4 and T3.

Sickle cell disease is a genetic disorder of hemoglobin causing myriad of pathology including anemia. The purpose of this study was to evaluate the baseline values of steady state hemoglobin and packed cell volume as a guide to managing the early recognition of hemolytic crises in sickle cell anemia. A cross-sectional study was conducted among the sickle cell patients attending the Sickle Cell clinic of Lagos State University Teaching Hospital, Ikeja. A blood sample of 4.5 ml blood was collected from each participant for hemoglobin concentration and packed cell volume. All blood samples were also screened for HIV and hemoglobin phenotypes were done using cellulose acetate hemoglobin electrophoresis at pH 8.6. A total of 98 subjects in steady state were recruited, consisting of 53 (54.1%) females and 45 (45.9%) males. The overall means were 7.92±1.49 and 24.46±4.76; a female mean of 7.73±1.45; 23.89±4.60, and a male mean of 8.14±1.54 and 25.14±4.91 were obtained for hemoglobin and packed cell volume, respectively. Sixty – nine of the 98 (70.40%) subjects have been previously transfused with blood. The mean hemoglobin concentration and packed cell volume in males was higher than females. The overall mean was lower than what was expected for age and sex. Over two-third of sickle cell anemia population had been transfused.

Metabolic syndrome (MS) is highly significant due to its association to type 2 diabetes and cardiovascular diseases. The purpose of this study was to compare the prevalence of MS according to the report of the Iranian National Committee of Obesity criteria (INCO) versus Adult Treatment Panel III (ATPIII) in Babol, North of Iran. Data obtained based on criteria ATP III from the Babol Lipid and Glucose Study (from July 2004 to September 2005) and were compared with the new INCO criteria 2010. The data were collected and analyzed. In total, 933 adult males and females were evaluated. According to ATP III criteria, the overall prevalence of metabolic syndrome was 23.7% (95% confidence interval: 21%-26.4%); 28.4% and 9.4% were females and males, respectively; however, the prevalence was 20.5% (95% confidence interval:17.9%-23.1%) according to the INCO criteria, 22.5% and 15.7% were females and males, respectively. The new INCO criteria for the metabolic syndrome proclaimed by the Iranian Committee of Obesity estimated a lower prevalence of syndrome in comparison with ATP III criteria in Babol.

Rise in serum homocysteine level may be associated with higher prevalence of cardiovascular diseases in hypothyroidism. Levothyroxine can partly diminish serum homocysteine level. Folic acid participates in homocysteine metabolic cycle in the human body. The effect of concomitant administration of folic acid and levothyroxine on serum homocysteine level was evaluated in the present study. Sixty patients with hypothyroidism participated in this double-blinded clinical trial study. They were divided into two equal groups; Group A received oral levothyroxine 50-100 µg daily. Group B took oral folic acid 1 mg on a daily basis in addition to levothyroxine with similar schedule to group A. The patients were followed up for two months. The serum homocysteine levels of these two groups were measured before and after the study. This study was registered in Iranian Registry of clinical trial (IRCT number: 201112077723N1). Mean serum homocysteine level fell from 11.5±4.2 to 9.9±3.5 mol/lit and from 11.2±3.1 to 6.9±1.9 mol/lit in group A and B, respectively (p<0.001). The mean reduction in serum homocysteine levels were 1.6±1.2 mol/lit and 4.3±1.4 mol/lit in group A and B, respectively (p<0.001). Levothyroxine can decrease serum homocysteine level partly; still its combination with folic acid empowers the effect. Combination therapy declines serum homocysteine level more successfully.

A number of former studies have shown that tuberculosis (TB) is higher in diabetes mellitus (DM) patients than non-diabetics. Both DM and TB are major public health problems in Iran, and because of the lack of investigation in this field in the region, we conducted this study to evaluate the prevalence of DM in admitted pulmonary tuberculosis patients. The medical files of documented tuberculosis cases and DM patients hospitalized in Infectious Diseases Ward in Razi Hospital in Ahvaz, southwest Iran from 2008 to 2010 were reviewed. The study population was divided into 2 groups as DM-TB and non-DM-TB. The data in the two groups were compared. One hundred and forty eight TB cases [36 (24.3%) DM cases with the mean age of 56.6±12.7 years, and 112 (75.7%) non-DM with mean age of 44.8±18.3 years] were studied. The estimated odds ratio (OR) of the association between DM and tuberculosis was 2.65 [(95% confidence interval (CI), 1.77 to 3.95), p<0.001]. There was significant difference in HIV infection, illicit drug use and imprisonment between the two groups (p<0.05). We found that the frequency of DM in TB patients in the region is more prevalent than it was expected. Tuberculosis had positive association to DM. DM might be an important risk factor for developing tuberculosis.

Diseases that cause acute flaccid paralysis (AFP) often progress rapidly, thus may cause life threatening complications, therefore, their diagnosis and cure are important. This study was carried out to investigate the causes of acute generalized weakness in children referred to Amirkola Children’s Hospital, in Babol, Iran. In this case series, the epidemiological causes of the disease and clinical features of 15 cases with acute generalized weakness from April 2005 to September 2010 were evaluated. The data were collected and analyzed. The mean age of cases was 4.7±3.5 years. The male/female ratio was 2. Twelve cases had Guillain-Barre syndrome, two with myositis and one with periodic hyperkalemic paralysis. Guillain-Barre syndrome is the most common cause of AFP in children admitted due to acute generalized weakness in Amirkola Children’s Hospital.

Chronic obstructive pulmonary disease (COPD) is a condition associated with inflammation in lungs and airways. The impacts of inflammatory process is not limited to respiratory system but extend to extrapulmonary organs with resultant complications involving endocrine, metabolic and cardiovascular systems. The extent and severity of inflammation may be partly estimated by serum measurement of several markers including serum CRP. Assessment of these markers can be useful not only for diagnostic or prognostic purpose but also for treatment evaluation of COPD patients. However, due to inconsistent results of published studies, at present the diagnostic or prognostic importance of inflammatory markers as well as their values in the evaluation of treatment outcome has not been accepted by all investigators. and so their routine applications require further studies. This review presents data in regard to the status of inflammatory markers at different stages of COPD patients and evaluates their predictive ability as well as their values in differential diagnosis or treatment evaluation.

Complete colonic duplication is a very rare congenital anomaly that may have different presentations according to its location and size. Complete colonic duplication can occur in 15% of gastrointestinal duplication. We report two cases of complete colonic duplications, and their characteristics. We present two patients with complete colonic duplication with different types and presentations. Case 1: A 2- year old boy presented to the clinic with abdominal protrusion, difficulty to defecate, chronic constipation and mucosal prolaps covered bulging (rectocele) since he was 6 months old. The patient had palpable pelvic mass with doughy consistency. Rectal exam confirmed perirectal mass with soft consistency. The patient underwent a surgical operation that had total tubular colorectal duplication with one blind end and was treated with simple fenestration of distal end, and was discharged without complication. After two years follow up, he had normal defecation and good weight gain. Case 2: A 2 –day old infant was referred with imperforate anus and complete duplication of recto-sigmoid colon, diphallus, double bladder, and hypospadiasis. After clinical and paraclinical investigations, he underwent operations in several stages in different periods, and was discharged without complications. After four years follow up, he led a normal life. The patients with complete duplication have to be examined carefully because of the high incidence of other systemic anomalies. Treatment includes simple resection of distal common wall, fenestration, and repair other associated anomalies.

Lung cancer ranks among the most common and most lethal malignancies worldwide. Once vascular or lymphatic invasions occur, metastatic dissemination to distant sites is common. Bone, liver, adrenals, and brain are the most frequent sites of the distant disease. In this study we present a case of squamous cell carcinoma of lung with metastasis of the left knee bursa. A smoker man presented with cough and hemoptysis and squamous cell carcinoma of lung was diagnosed. Fourteen months later he developed pain and swelling of left knee. The biopsy and pathologic examination of the left knee bursa showed involvement of the bursa. Squamous cell carcinoma of lung can metastasize in the unusual sites of the body.