فهرست مطالب محمود اکبریان

The aim of current study was comparing the diagnostic performance of computed radiography with that of analog radiography in evaluation of interstitial lung pattern based on histopathology as a gold standard. Twenty domestic shorthair cats apart from weight, age and gender differences after clinical examination were studied in lateral and ventrodorsal projections with both computed and analog radiography. Then, three radiologists independently evaluated the radiographs. Histopathology investigation used as gold standard to confirm the interstitial lung pattern detected on the radiographs. Statistical data of two radiologic approaches were analyzed by Cohen’s Kappa test and the sensitivity and specificity of each approach were also calculated. The agreement for the interstitial lung pattern was fair for both systems, but computed radiography was more sensitive. In current study the ability of computed radiography was equivalent or superior to conventional radiography for evaluation of interstitial lung pattern, since displaying more radiographic details. Accordingly, it can be a proper substitute for analog radiography considering its advantages including elimination of dark room, high contrast resolution and wide dynamic range.

Pregnancy in women with systemic lupus erythematosus (SLE) is still introduced as a major challenge. Consulting before pregnancy in these patients is essential in order to estimating the risk of undesirable maternal and fetal outcomes by using appropriate information. The purpose of this study was to develop an artificial neural network for prediction of pregnancy outcomes including spontaneous abortion and live birth in SLE. In a retrospective study, forty-five variables were identified as effective factors for prediction of pregnancy outcomes in systemic lupus erythematosus. Data of 104 pregnancies in women with systemic lupus erythematosus in Shariati Hospital and 45 pregnancies in a private specialized center in Tehran from 1982 to 2014 in August and September, 2014 were collected and analyzed. For feature selection, information of the 149 pregnancies was analyzed with a binary logistic regression model in SPSS software, version 20 (SPSS, Inc., Chicago, IL, USA). These selected variables were used for inputs of neural networks in MATLAB software, version R2013b (MathWorks Inc., Natick, MA, USA). A Multi-Layer Perceptron (MLP) network with scaled conjugate gradient (trainscg) back propagation learning algorithm has been designed and evaluated for this purpose. We used confusion matrix for evaluation. The accuracy, sensitivity and specificity were calculated from the confusion matrix. Twelve features with P<0.05 and four features with P<0.1 were identified by using binary logistic regression as effective features. These sixteen features were used as input variables in artificial neural networks. The accuracy, sensitivity and specificity of the test data for the MLP network were 90.9%, 80.0%, and 94.1% respectively and for the total data were 97.3%, 93.5%, and 99.0% respectively. According to the results, we concluded that feed-forward Multi-Layer Perceptron (MLP) neural network with scaled conjugate gradient (trainscg) back propagation learning algorithm can help physicians to predict the pregnancy outcomes (spontaneous abortion and live birth) among pregnant women with lupus by using identified effective variables.

Cytotoxic lymphocyte antigen-4 (CTLA-4) plays an important role in regulating T cell activities. CTLA-4 gene polymorphisms are associated with genetic susceptibility to various autoimmune diseases, including systemic lupus erythematosus (SLE). The present study was conducted to analyze the role of CTLA-4 polymorphism at positions −1722TC in patients suffering from SLE. Samples were collected from 180 SLE patients and 304 healthy people. Both groups were equal in terms of age and ethnicity. Polymerase chain reaction restriction fragments length polymorphism (PCR-RFLP) was used to analyze the genotype and allele frequencies of these polymorphisms. Data were analyzed by SPSS software. No statistically significant difference was observed between the studied genotypic and allelic frequencies, SLE patients and the controls. There was a significant correlation between age range 15-45 and TT genotype (P<0.0001). However, no significant correlation was found between other risk factors and different genotypes. The results suggested that 1722TC polymorphism in the promoter region of the CTLA-4 gene does not play any role in the genetic susceptibility to SLE.

Patients with systemic lupus erythematosus (SLE) may develop hearing and balance disorders as a result of the immune-mediated inner ear damage. Vestibular evoked myogenic potential (VEMP) is a new vestibular test assesses the vestibulospinal tract. Balance disorders such as endolymphatic hydrops may occur as a result of perisaccular deposition of immune complexes in these patients. Although the vestibular system abnormality in the patients has been demonstrated، the function of the part of vestibular system including vestibulospinal tract has not been investigated so far. This study aimed to compare the vestibular evoked myogenic potentials between patients with inactive stage of systemic lupus erythematosus and normal individuals.

In this cross-sectional study، vestibular evoked myogenic potential was recorded between 26 healthy subjects and 20 patients with lupus erythematosus in inactive stage of disease aged 20 to 50 years old، using 500 Hz-tone bursts at 95 dB nHL.

Vestibular evoked myogenic potentials responses were present in all (100%) of the participants. There was no significant difference in mean peak to peak amplitude and assymetry ratio between two groups. The mean p13 and n23 latencies were significantly higher in patients (p<0. 05). Duration of disease had no effect on test parameters.

According to the prolonged latency of vestibular evoked myogenic potentials response in patients with lupus erythematosus، lesions in the retrolabyrinthine، especially in the vestibulospinal tract is suspected. Due to small sample size، there is no possibility for generalizing this result to all patients with lupus lupus erythematosus.

Systemic lupus erythmatous (SLE) is a disease of unknown etiology with wide variety of clinical and immunological features. Our objective was to describe the clinical manifestation and laboratory data in Iranian male patients. 2279 patients were entered in a cross sectional study. The data were collected from rheumatologic research center in Shariati hospital of Tehran University. The prevalence of clinical and immunological features were compared between male and female patients 227 patients (9.7%) were male and 2052 (90.3%) patients were female. A higher frequency of discoid rash and urine casts and a lower frequency of arthritis and leucopenia were demonstrated in our male patients (P

Systemic Lupus Erythematosus (SLE) is a prototypic autoimmune disease with diverse clinical manifestations in association with autoantibodies to components of the cell nucleus. SLE as a chronic autoimmune disease has a worldwide distribution. There is a wide variation in the natural history of SLE among different ethnic and geographic groups. Our SLE registry is one of the largest series in Asia-Pacific region.

24-h urinary pr is a standard way to diagnose lupus nephritis. Assessment of Pr/Cr ratio in morning spot urine is a valuable method in diabetic patients but it has no use in SLE patients routinely. In this study Pr/Cr ratio in spot urine was compared with 24-h urine Pr. If they have valuable correlation, we can use this test instead of 24-h urinary Pr. The aim of this study was to evaluate the correlation of spot urine protein-creatinine ratio for prediction of significant proteinuria (> or = 300 mg/24 h) in patients with systemic lupus erythematous.A cross-section study was conducted in 74 hospitalized women with systemic lupus erythematous. The correlation between Prot/Cr in first morning urine specimens and urinary protein excretion were analyzed in 24-h collections.zorrelation between Prot/Cr ratio in spot morning urine specimens and urinary protein excretion in 24-h collections was significant.A high correlation and precision of agreement were demonstrated between the two methods of assessment proteinuria in lupus patients. The difference between the two methods was less than the biological variability in the protein excretion and its measurement, enabling the methods to be used interchangeably creatinine ratio in spot morning urine samples is a precise indicator of proteinuria in patients with lupus nephritis and represents a simple and inexpensive procedure in establishing severity of proteinuria in patients with systemic lupus erythematous.

The components of the classical complement pathway play an important role in the pathogenesis of systemic lupus erythematosus (SLE) and are reportedly useful biomarkers of disease activity. In this study, we evaluate disease activity, complement function (total hemolytic complement, CH50) and complement protein levels (C3, C4, C3d, C4d, SC5b-9), comparing the results of patients with active disease versus those with inactive disease. This cross-sectional study included 78 hospitalized women with SLE, 24 of whom were in the active group, with SLE disease activity indexes

Systemic lupus erythematosus (SLE) is a disease with life-threatening complications. Since evidence indicates that measurement of triglyceride (TG) and HDL levels and tumor necrosis α factor (TNF- α) and its types I and II soluble receptors plays a major role in evaluation of lupus activity, this study was conducted to investigate the relationship between the above mentioned factors and lupus activity in Tehran in 2005. In this cross-sectional study fasting blood samples were obtained from 86 SLE patients who had been entered into the study through convenient sampling and the disease activity was calculated using the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI]. Scores ≥ 6 were considered as active lupus and <6 as dormant lupus. Serum levels of TNF- α, sTNFR1 and sTNFR2 were measured through ELISA (Bender Medsystem) and blood TG and HDL through routine biochemical tests within 12 hours overnight fasting. The results were analysed by t-test, Mann-Whitney and Pearson correlation tests. 46 people (53.5%) suffered from dormant disease and 40 people (46.5%) from active disease. TG level had significant relationship with disease activity, sTNFR2 (P=0.001) and TNF-α (P=0/01), while HDL level had inverse significant relationship with SLEDAI (P=0.007), TNF (P=0.01), STNFR1 (P=0.001). There was no significant relation between TG and HDL with STNFR2. Multiple linear analysis of regression showed that three variables (TG, sTNFR1 and sTNFR2) are maintained in the model for prognosis of the disease while TNF-α and HDL are omitted. Dislipoproteinemia (elevated TG and reduced HDL) correlates with SLE activity following an increase in TNF-α and its soluble receptors. Thus, serum levels of TG, HDL and TNF-α and its soluble receptors are connected with lupus activity and are valuable markers for the disease activity.

There is not yet a pathognomonic laboratory test for the diagnosis of Behcet’s Disease (BD). The diagnosis is therefore based on clinical manifestations. Mucocutaneous lesions are the most important and the most frequent clinical manifestations of BD.

To study the mucocutaneous lesions systematically. In a great number of patients. Some of these clinical pictures are poorly defined in the literature, and some of them are still unknown.

From 1992 to 1998 we screened systematically all patients attending the Behcet’s Disease Research Unit (BDRU), Rheumatology Research Center, Tehran University for Medical Sciences, for mucocutaneous lesions. Only recurrent lesions were taken in consideration. A total of 3751 patients were seen and registered in our database. The mean number of new patients seen every year, during the last 10 years, was 302 patients per year.

Besides the classical lesions, we observed unusual and rare forms of mucous membrane, cutaneous, and subcutaneous lesions. Mucous Membrane lesions: 1) Oral aphthosis is the most important lesion of BD (96.1%±0.6). They are not different from other aphthosis, but they are often smaller. There are also the Punctiform, the Miliaria, and the Herpetiform aphthosis. 2) Genital aphthosis was seen in 63.9%±1.5 of patients. In females they are often larger, deeper, and very painful. Giant forms are seen sometimes. In male they are seen more often on the scrotum. Recurrent conjunctival aphthosis is rare. It is small and ephemera. 3) Ulceration and erosions are different from aphthous lesions. They can take multiple and various shapes without a specific characteristic. 4) Purpura and erythema may also be seen on the mucous membrane. Skin Lesions: Is the second most frequent manifestation of BD. It was seen in 67.4%±1.5 of the patients. The pathergy phenomenon, which is a skin hyper reactivity to trauma, was seen frequently in BD. The most important cutaneous lesions of BD is the pseudo folliculitis. It is a small erythematous lesion, surmounted in the center by a round and non-acuminated pustule, which is dome shaped, sterile, and without hair in the center. They are situated mainly on the lower limbs. Other lesions are 1) Small round erythemato-edematous lesions. 2) Cutaneous aphthosis, which is the most characteristic lesion of BD. It is a round and punched out ulceration with a white yellowish necrosis on the bottom. It leaves a scar after healing. 3) Small nodules. 4) Behcet’s Cellulitis; it is a large painful erythematous lesion. It is not infectious nor a superficial thrombophlebitis. In the literature, it was mistakenly taken as Sweet syndrome. The biopsy in all lesions shows a vasculitis, leucocytoclastic or lymphocytic. Subcutaneous Lesions: Erythema nodosum is seen in 22.8%±1.3 of cases. It is a frequent and relapsing lesion. It is a subcutaneous node, painful, red mauve, with different sizes, and often surrounded with an erythematous and edematous ring. Other lesions are rarely seen 1) Subcutaneous lesions, like Erythema Induratum of Bazin. 2) Suppurative panniculitis.

Our study showed a wide variety of muco-cutaneous lesions. The lesions are not specific of BD, but they have their own characteristic. Those characteristics, along with the coexistence of different forms, can help to diagnose BD.