فهرست مطالب حسن محمودی نشلی

 Urinary tract infections (UTIs) are among the most common bacterial and frequently recurring infection during childhood, especially in the ages of three months that can involve upper UTI (pyelonephritis) and lower UTI (cystitis). There are three forms of urinary tract infections include pyelonephritis, cystitis and bacteriuria without symptoms.  Approximately 10-30% of children experience a urinary tract infection in the early years of life. The prevalence of UTI has estimated 36.8% in some third world countries. Enterobacteriacea, especially Escherichia coli has been detected as the most common cause of UTI. The crucial criteria to diagnose of UTI are including: fever, pyuria, the growth of organism more than 105  colonies in culture medium. Nowadays, antibiotic resistance is a global concerning among pediatric patient with UTI. The other important issues are including, urine reflection and scar in the lining of the kidney tissue, failure in growth and function of kidney, chronic of kidney and eventually kidney graft and dialysis. So fast diagnostic and treatment of these patients to prevent of development is so important. Although DMSA scanning is a gold standard to detect of renal parenchymal tissue involvement but due to high cost, no accessible in all of the clinical centers and exposure to dangerous chemical substances of radioactive, it is used less. Some clinical symptoms, such as fever, stomachache, backache, nausea, anorexia and inflammatory markers such as white blood cell (WBC), Erythrocyte sedimentation rate (ESR),C_ Reactive Protein (CRP ) can be handy methods to detect of the site of urinary infectious, but it is not reliable method. So there is not a practical, fast and reliable method to separate of pyelonephritis and cystitis. Pyelonephritis can lead to scar and the next stages high blood pressure and kidney failure. The prevalence of kidney scars due to pyelonephritis had reported 26.5% to 49%.  Mean platelet volume (MPV) is an important index in detection of inflammatory. The aim of this study was to investigate the value of MPV in differentiation of pyelonephritis from cystitis in children with UTI.

In this analytical cross- sectional and diagnostic study which was approved by the Ethics Committee of Babol University of Medical Sciences, Babol, Iran, with the ethics code IR. MUBABOL1724132572, a total of 141 children (1 month to 18 years) with urinary tract infections hospitalized in pediatric Hospital of Amirkola, Babol were enrolled from 2015 to 2020. Inclusion criteria including positive urine culture and exclusion criteria including negative urine culture, lack of diagnosis of pyelonephritis and cystitis, lack of cooperative of patients and the history of blood disorder associated with abnormal platelets (Bernard-Soulier syndrome, gene mutation myh9, ITP).
Considering the inclusion and exclusion criteria, diagnosis of pyelonephritis and the result of positive culture, patients enrolled to this study. And then, whole blood specimens from patients were collected to detect of MPV, CRP, and ESR. According to traditional guidelines, chocolate/ blood agar (non selective medium) used for routine urine cultures.
MPV was investigated and compared between patients with pyelonephritis and cystitis. Diagnostic value of MPV by statistical indicators specificity, sensitivity and AUC were calculated and finally statistical analysis of data was carried out using the SPSS (v 16.0) software package.The statistical tests, such as chi- square test, independent t- test, Mann withney, Spearman rank correlation, ROC and Kolmogorov-Smirnov were used in this study. P-Value less than 0.05 were assumed as statistical significance. MPV was evaluated in patients with pyelonephritis and cystitis by independent t- test. Correlation analytical was used to detect of relationship between MPV, ESR, CRP and leucocytes among two groups of pyelonephritis and cystitis. ROC (Receiver Operating Characteristics Curve) was used to evaluate and comparison of sensitivity, specificity and the area under the curve for the MPV in patients with pyelonephritis and cystitis.

Among 141 patients with UTI, 63.8% with pyelonephritis and 36.2% with cystitis enrolled in this study. MPV in patients with reflux was detected 8.67± 0.95 fl and in patients without reflux was detected 8.66± 0.99 fl. This finding was no statistically significant difference between MPV and reflux (P= 0.96). In this study, according to two groups of patients with pyelonephritis and cystitis the frequency of bacteria was investigated. The most common pathogen among both groups of patients was detected Escherichia coli. There was no statistically significant between type of pathogen among two groups ( P= 0.167).  The result of laboratory variables investigation in both groups of pyelonephritis and cystitis were detected 8.7 fl and 8.5 fl, respectively. There was no statistically significant difference between two groups (P= 0.329). Although there was no statistically significant difference in platelet count (P= 0.374), leucocyte (P= 0.115) and lymphocyte (P= 0.073), but we found statistically significant differences in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) between two groups, (P= 0.001). MPV comparison results between two groups (pyelonephritis and cystitis) showed there was no statistically significant difference between two groups.  There was no statistically significant between MPV and ESR, CRP and leucocyte, (P> 0.05).

According to the result of our study, the role of MPV in differentiating pyelonephritis from acute cystitis was detected. The evidence of this study showed MPV has low diagnostic value in differentiating pyelonephritis from acute cystitis in children with UTI.  So, detection of Mean platelet volume is not an appropriate method and it needs to more studies to find Para clinical factor in diagnostic is worth wealthy.

Human T-cell leukemia virus type 1 (HTLV-1) is a virus that is endemic in some parts of the world, and as a pathogen, it can lead to severe infections in humans. Since no antiviral treatment is currently available and the only way of confrontation is prevention and identification of infected blood, this study was performed to determine the frequency of antibodies against HTLV-1 in patients with rare bleeding disorders receiving blood in Zahedan.

The study population included 180 patients with rare bleeding disorders referred to Ali Asghar Hospital in Zahedan selected by census method and 90 healthy individuals who referred to hospital lab selected by convenience sampling method in 2020. Age range was 1 to 39 years. Blood samples were collected from all participants and antibody test against HTLV-1 was confirmed using ELISA kit and positive ELISA test was confirmed using Real-time PCR.

In the case group, there were 86 men (47.8%) and 94 women (52.2%) and in the control group there were 43 men (47.8%) and 47 women (52.2%). Antibodies against HTLV-1 were found in 2 patients (1.1%) with rare bleeding disorders and none in healthy individuals. The first was a 29-year-old man with Glanzmann's disease who had severe Glanzmann's thrombasthenia. The second case was a 23-year-old woman with severe forms of factor V and factor VIII deficiency whose family history of Rare Bleeding Disorders (RBD) was positive.

The results of the study showed that the risk of HTLV-1 transmission through plasma-induced blood products and new types of coagulation factors seems negligible.

Beta-thalassemia major is a genetic disorder with known globin defect that leads to chronic hemolytic anemia. Due to the need for recurrent blood transfusion, the risk of infectious diseases such as hepatitis is higher in these patients.

This cross-sectional study recruited 518 patients with thalassemia major in Amirkola Thalassemia Center, 2013-2014 who were selected via census sampling. Patients' blood samples were analyzed for HBsAb, HBsAg, and HCVAb by ELISA test. Data were analyzed in
SPSS V22.

The patients included 268 (51.7%) females and 250 (48.3%) males with the mean age of 27.93±9.88 years. The study showed that 5.79% of patients with thalassemia major were infected with HCV, including 11 (4.4%) males and 19 (7.1%) females and only one male patient was found to be HBsAg positive.

The study showed lower incidence of hepatitis C compared to previous reports from Amirkola Thalassemia Center. In current study the prevalence of HBsAg was also found to be low.

Thalassemia is the most common genetic disorders in the world. There are more than 20. 000 beta thalassemia major patients in Iran. Most parts of the world، including Iran، apply a national program of thalassemia prevention. In our country، prenatal diagnosis and pregnancy termination has been an effective program in this area. But some studies do not consider this method appropriate. The aim of this study was to evaluate the attitude of thalassemia minor couples having a thalassemia major fetus.

This study was done on 65 thalassemia minor couples having a thalassemia major fetus from January 2008 till February 2009 and both couples answered the questionnaire in a quiet place without a questioner (a person asking question).

The ages of mothers and fathers were 17 to 35 years (24±4. 65 years) and 22 to 39 years (30. 36±5. 23) respectively. All couples except one attempted abortion and all of them were upset of having a thalassemia major fetus.

Although the legal abortion with the approval of religious leaders as long as 16 weeks of gestational age is performed in Iran، and in our study 98. 4% of cases had attempted abortion awared of thalassemia major person’s future، but all families were hurt with the happened insident. So، further investigations should be done for the couples’ complications. It is recommended to reduce the physical and psychological complications of couples using PGD method rather than CVS.