Shifting paradigms in the management of pediatric differentiated thyroid cancer from static to dynamic risk stratification: a step forward toward precision medicine.

INTRODUCTION: This study aimed to assess the usefulness of a risk-adopted management system known as dynamic risk stratification (DRS) in comparison with the American (ATA) and European Thyroid Associations' (ETA) risk classifications in the management of pediatric patients with differentiated thyroid cancer (DTC). MATERIALS AND METHODS: The current study included 50 pediatric patients with DTC who were treated with total or near total thyroidectomy and radioiodine ablation whose risk assessment was initially defined according to the ATA and ETA guidelines. During the two years after initial treatment, patients were reclassified according to their DRS. RESULTS: The study showed that the ability of the DRS system to predict the final outcome was superior to that of the ATA and ETA guidelines. The observed variance in predicting final outcome was 2.3 % for ETA, 14.8 % for ATA, and 83.4 % for DRS. In intermediate/high-risk patients, according to the ATA/ETA guidelines, an excellent response to initial therapy resulted in a noteworthy reduction (about 40 %) for detection of structural disease at the time of final follow-up. The risk of structural disease at the time of final follow-up was significantly higher in the structural incomplete response group (HR = 23.34, P = 0.00) and biochemical incomplete response group (HR = 13.83, P = 0.03) than in the excellent response group. CONCLUSION: The data documented the significance of re-stratifying pediatric patients with DTC on the basis of the findings obtained at the time of or after their initial therapy (total thyroidectomy and radioiodine ablation), predominantly in the intermediate/high-risk patients. In addition, DRS helped to better modulate the later follow-up, excluding a large number of intermediate/high risk patients from needless intensive workups, allowing personalization of follow-up management.

An update on radiation absorbed dose to patients from diagnostic nuclear medicine procedures in Tehran: A study on four academic centers.

PURPOSE: Use of radiopharmaceuticals for diagnostic nuclear medicine procedures is one of the main sources of radiation exposure. We performed this study with respect to the rapid growth in nuclear medicine in Iran and lack of updated statistics. MATERIALS AND METHODS: The data were obtained for all active Nuclear Medicine Centers affiliated to Shahid Beheshti University of Medical Sciences during 2009 and 2010. RESULTS: The most frequently performed procedures were bone (30.16%), cardiac (28.96%), renal (17.97%), and thyroid (7.93%) scans. There was a significant decrease in the number of thyroid scintigraphies with (131)I and (99m)Tc-sulfur colloid liver/spleen scans and tremendous increase in the frequencies of cardiac and bone scintigraphies compared to one decade ago. CONCLUSION: Compared to previous studies, there were striking changes in trends of diagnostic nuclear medicine procedures in Tehran. This field is still evolving in the country, and this trend will further change with the introduction of positron emission tomography scanners in future.

The effect of a new impregnated gauze containing bentonite and halloysite minerals on blood coagulation and wound healing.

In recent years, a wide variety of research has been carried out in the field of novel technologies to stop severe bleeding. In several studies, coagulation properties of minerals such as zeolite, bentonite and halloysite have been proven. In this study, the effect of a new impregnated sterile gauze containing bentonite and halloysite minerals was studied on blood coagulation and wound healing rate in male Wistar rats. Initially, impregnated sterile gauze was prepared from the mixture of bentonite and halloysite minerals and petroleum jelly (Vaseline). Then, the effect of gauze was studied on the blood coagulation time and wound healing process in 40 Wistar rats. SPSS software was used for data analysis and P values less than 0.05 were considered significant. The coagulation time of 81.10 ± 2.532 s in the control group and 33.00 ± 1.214 s in the study group (bentonite-halloysite treated) were reported (P < 0.0005). Time for complete wound healing in the group, which is treated with impregnated sterile pads, was calculated approximately from 10 to 12 days. However, in the control group, there was no complete wound healing (P < 0.0005). According to the results of the present study, topical application of the bentonite-halloysite impregnated sterile gauze significantly decreases the clotting time and increase the wound healing rate.

Hyponatremia a valuable predictor of early mortality in patients with cirrhosis listed for liver transplantation.

The current policy for organ allocation in liver transplantation is to give priority to the sickest patients mostly using model for end-stage liver disease (MELD) score in ranking. However, other factors as serum sodium may be of value in predicting early mortality. In this single-center study, patients with cirrhosis over age 14 on the liver transplant wait-list from September 1998 to June 2007 were followed for six months from the time of listing to evaluate the value of hyponatremia on mortality. Of 612 listed patients, 51 were transplanted who were excluded from survival analysis and 55 died without transplantation within the first three months. The numbers of transplanted and dead patients during months 3-6 were 29 and 24, respectively. Both MELD score and serum sodium at the time of listing were independent predictors of early mortality. On bivariate analysis, serum sodium of <130 mEq/L beside MELD was a significant predictor of mortality within 90 and 180 d. Serum sodium level <135 mEq/L masked the difference in mortality between patients with refractory and non-refractory ascites. Serum sodium level of <130 mEq/L and an increased MELD score are significant predictors of early mortality in patients listed for liver transplantation.

A urine-based polymerase chain reaction method for the diagnosis of visceral leishmaniasis in immunocompetent patients.

In the Mediterranean basin and Middle East, including Iran, visceral leishmaniasis (VL), also known as kala-azar, is caused by Leishmania donovani infantum. For the first time, the use of urine samples for the diagnosis of VL in immunocompetent patients has been used in this study. Based on its high sensitivity and specificity, as well as simplicity, this approach can serve as a valuable tool in the diagnosis of VL. We studied 60 urine samples from 60 individuals, 30 of which were patients with VL confirmed by parasitology, serology, or molecular methods, 5 were from healthy individuals, and 25 were from patients with cutaneous leishmaniasis, malaria, brucellosis, and hydatid cyst. Out of 30 samples from confirmed VL immunocompetent patients, 29 were positive (sensitivity, 96.8%) by polymerase chain reaction (RV1 and RV2 primers), and all the remaining 30 samples either from healthy individuals or patients with other diseases were negative (specificity, 100%). High sensitivity, specificity, and simplicity of the test can serve as a valuable tool in the diagnosis of VL.

Comparison of biotyping and antibiotyping of Pseudomonas aeruginosa isolated from patients with burn wound infection and nosocomial pneumonia in Shiraz, Iran.

The objective of present study was to compare and determine the prevalence ofantibiotypes and biotypes of Pseudomonas aeruginosa isolated from patients with burn infection and nosocomial pneumonia in Shiraz, Iran. Thirty isolates from each group of patients were used. Antibiotyping (antibiotic sensitivity profiles) was performed by disk diffusion of Bauer-Kirby method using eleven antibiotics and biotyping (biochemical profiles) was done by standard biochemical procedures. High rate of multi-drug resistant isolates were observed by both groups of patients. P. aeruginosa isolated from burn infection were found more resistant (26.7%) to the all antibiotics used than those from nosocomial pneumonia (6.7%) p < or = 0.04. All P. aeruginosa (100%) isolates from burn infection were resistant to gentamycin, carbenicillin, cephtazidime and cephalothin. The lowest resistance rate was observed with meropenem. Antibiotic susceptibility profiles revealed 11 and 15 different antibiotypes among P. aeruginosa isolates from patients with burn infection and nosocomial pneumonia, respectively. The biochemical profiles consisting of 21 biochemical tests grouped P. aeruginosa into 8 different biotypes. Biotypes BVIII 15(50%) and BIII 11(36.7%) were the most prevalent isolates from burn infection and nosocomial pneumonia, respectively p < or = 0.04. Data obtained in this study revealed that different types of Pseudomonas aeruginosa are involved in burn wound infection and nosocomial pneumonia in this region.