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1.  Aetiologic Agents of Fevers of Unknown Origin among Patients in Benin City, Nigeria 
Background:
Malaria parasitaemia is an important predictor of bacteremia, concomitant invasive bacterial infections and malaria parasitaemia are strongly associated with death.
Methods:
Blood samples were collected from 500 patients (281 males and 219 females) with fevers of unknown origin. The blood samples were processed to diagnose malaria and bacterial septicaemia using standard microbiological techniques.
Results:
The prevalence of concomitant bacterial septicaemia and malaria parasitaemia was 7.8%. The prevalence of malaria parasitaemia alone (26.2%) was significantly (P < 0.0001) higher than that of bacterial septicaemia (13%). Patients 61 years old and older had higher prevalences of malaria parasitaemia, bacterial septicaemia, and concomitant infections. The most prevalent organism causing bacterial septicaemia were of the Klebsiella species, while ceftriaxone and ceftazidime were the most effective antibacterial agents.
Conclusion:
Overall prevalence of malaria parasitaemia, septicaemia and concomitant malaria parasitaemia, and bacterial septicaemia were 26.2%, 13%, and 7.8%, respectively. Bacteria from the Klebsiella species were the most common bacteria causing septicaemia. Although ceftriaxone and ceftazidime are the recommended treatments, there is need for urgent treatment of concomitant infections due to their poor prognosis.
PMCID: PMC3952337  PMID: 24639610
malaria; bacterial septicaemia; prevalence
2.  Pathogenesis and Immune Response in Tuberculous Meningitis 
Cerebral tuberculosis is the most severe type of extrapulmonary disease that is in developing countries highly predominant in children. Meningeal tuberculosis is the most common form and usually begins with respiratory infection followed by early haematogenous dissemination to extrapulmonary sites involving the brain. In comparison with the lung, Mycobacterium tuberculosis induces a very different immune response when infect the central nervous system. Herein, we review several aspects of the pathogenesis and immune response in pulmonary and cerebral tuberculosis in humans and experimental models and discuss the implications of this response in the cerebral infection outcome.
PMCID: PMC3952336  PMID: 24639606
tuberculosis; tuberculous meningitis; cerebrospinal fluid
3.  Advanced Stage T-Cell Non-Hodgkin lymphoma in an 11-Month-Old Infant and Related Superior Vena Cava Syndrome: Importance of Transthoracic Echocardiography 
Superior vena cava syndrome (SVCS) is rare in infants. Non-Hodgkin lymphoma is the most common cause of SVCS in children. Swelling in the face and neck are the most common clinical symptoms associated with this syndrome. However, these clinical findings are also observed in allergic diseases, which therefore often leads to misdiagnosis. Here, we reported the importance of echocardiography in diagnosing SVCS in an infant with advanced stage non-Hodgkin lymphoma.
PMCID: PMC3952338  PMID: 24639614
superior vena cava syndrome; non-Hodgkin lymphoma; echocardiography; infant
5.  Correlation of Common Biochemical Markers for Bone Turnover, Serum Calcium, and Alkaline Phosphatase in Post-Menopausal Women 
The quality of life for women after menopause is one of the key health issues today, and osteoporosis is a silently progressing metabolic bone disease widely prevalent in post-menopausal women in India. Rapid bone loss occurs in post-menopausal women due to hormonal factors that lead to an increased risk of fractures. Thus, the present study was undertaken to observe the serum calcium and alkaline phosphatase (ALP) levels in post-menopausal women as these substances are biochemical markers of bone metabolism. In this small-scale cross-sectional study, 100 samples were taken. Of these, 50 were taken from post-menopausal women (experimental group) and 50 were taken from pre-menopausal women (control group). Serum calcium and serum ALP were measured in the blood samples of both groups. The findings demonstrated that the serum calcium level was significantly lower in the post-menopausal group than in the pre-menopausal group, while the ALP level was slightly higher. Therefore, an increase in bone turnover accelerates bone mass reduction in post-menopausal women, whereas a decrease in bone turnover is associated with the preservation of bone mass.
PMCID: PMC3952340  PMID: 24639613
alkaline phosphatase; calcium; menopause; osteoporosis
6.  Mirizzi Syndrome Type II with Cholecystoduodenal Fistula: An Infrequent Combination 
We report a case of Mirizzi syndrome type II associated with biliary enteric fistula. It is important to identify this combination early, as it is associated with high morbidity. In our case, intraoperative findings were cholecystoduodenal fistula and communication of Hartmann’s pouch with common bile duct (CBD). A subtotal cholecystectomy with excision of cholecystoduodenal fistula was performed. A minimal surgical maneuver of Calot’s Triangle with repair of cholecystoduodenal fistula is required during the intraoperative period.
PMCID: PMC3952341  PMID: 24639616
cholecystoduodenal fistula; gallstones; Mirizzi syndrome
7.  Present and Future of Neurosurgery Training and Education 
Multiple challenges are faced by educators and trainees. These challenges are multidimensional and pertain to a scenario in which trainees have to become in a short period of time competent technical neurosurgeons, while at the same time conscious of economic and professional factors that will influence their practice. It is the duty of societies and leading educators to come together in developing continental methods of training aimed towards “organised learning”. The goal should strictly be the education of our residents, not just the utilisation of their manpower for a number of years.
PMCID: PMC3952342  PMID: 24639605
certification; competency; education; neurosurgery; training
8.  Primary Tuberculosis of the Cheek: A Common Disease with a Rare Presentation 
Tuberculosis of the extra-oral region is uncommon and is rarely primary. Extra-oral involvement of the cheek in the absence of tuberculosis elsewhere in the body is rare. To the best of our knowledge, we report here the first case of primary tuberculosis of the cheek in a 31-year-old male presenting as a nodular swelling of the cheek. Previous reported cases of extra-oral involvement of the cheek involved either fistula or sinus of the cheek. Excisional biopsy for tissue diagnosis and bacterial examination with culture should be performed for an early diagnosis as a delay in treatment can lead to devastating consequences.
PMCID: PMC3952343  PMID: 24639615
cheek; extraoral; tuberculosis; primary
9.  Validation Study of the Malay Version of the Work-Family Conflict Questionnaire 
Background:
Work-family conflict has received increasing attention in recent decades in the area of workplace stressors, which can affect employees’ health. However, the dimensionality of the work–family conflict construct among the Malay-speaking population has not been clarified. In order to do so, it is crucial to use an instrument that is appropriate and valid for the Malay-speaking population. As such, the goal of this study was to validate and test the dimensionality of the Malay version of the Work-Family Conflict Questionnaire.
Methods:
The present study conducted exploratory factor analysis, confirmatory factor analysis, discriminant validity, convergent validity, and internal consistency, using Cronbach’s alpha, of the work–family conflict construct among 332 working women in Malaysia.
Results:
The results supported the existence of four dimensions in the Work-Family Conflict Questionnaire that distinguish between time based and strain-based work-family conflict and family-work conflict. The discriminant validity, convergent validity, and internal consistency of this construct are adequately supported.
Conclusion:
The findings of this study supported the existence of discriminant and convergent validity, as well as adequate reliability, for the construct. Thus, the Work–Family Conflict Questionnaire is a valid and reliable instrument among Malay-speaking working women.
PMCID: PMC3952344  PMID: 24639612
factor analysis; validity and reliability; working women; professional-family relation
10.  Serum Fibronectin Levels in Acute and Chronic Viral Hepatitis Patients 
Background:
The aim of this study was to investigate the serum fibronectin (FN) levels and liver enzyme activities in patients with acute hepatitis (A, B, C) and chronic viral hepatitis (B, C); determine whether the virus types correlated with disease severity; and assess whether FN could be used as a marker of virus type or disease severity in patients.
Methods:
A total of 60 subjects were enrolled in the study, including 20 patients with acute hepatitis (A, B, C), 20 with chronic hepatitis (B, C), and 20 healthy controls. Serum fibronectin (FN), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), and albumin were measured in all patients from blood samples.
Results:
Serum FN levels were significantly lower in acute (122.9 μg/mL (SD 43.1), P < 0.001) and chronic hepatitis patients (135.7 μg/mL (SD 46.0), P < 0 .001) compared to controls 221.4 μg/mL (SD 32.5). A negative correlation was found between serum FN and AST (r2 = 0.528, P < 0.001), ALT (r2 = 0.425, P < 0.001), and GGT (r2 = 0.339, P < 0.001). Additionally, high serum GGT levels (β = –0.375, P = 0.010), and low serum albumin levels (β = –0.305, P = 0.008) were associated with low serum FN levels.
Conclusion:
Serum FN levels were lower in both acute and chronic hepatitis patients, and an inverse relationship between serum FN and serum AST, ALT, and GGT levels was found. A decrease in serum FN levels may indicate hepatitis severity as AST and ALT represent hepatocyte damage.
PMCID: PMC3952345  PMID: 24639609
fibronectin; hepatitis; chronic hepatitis; liver fibrosis; albumin
11.  Effects of Cholestasis on Learning and Locomotor Activity in Bile Duct Ligated Rats 
Background:
Cognitive functions are impaired in patients with liver disease. Bile duct ligation causes cholestasis that impairs liver function. This study investigated the impact of cholestasis progression on the acquisition and retention times in the passive avoidance test and on the locomotor activity of rats.
Methods:
Cholestasis was induced in male Wistar rats by ligating the main bile duct. Locomotor activity, learning and memory were assessed by the passive avoidance learning test at day 7, day 14, and day 21 post-bile duct ligation. The serum levels of bilirubin, alanine aminotransferase, and alkaline phosphatase were measured.
Results:
The results showed that acquisition time and locomotor activity were not affected at day 7 and day 14, but they were significantly (P < 0.05) impaired at day 21 post-bile duct ligation compared with the results for the control group. Additionally, memory was significantly impaired on day 7 (P < 0.01), day 14, and day 21 (P < 0.001) compared with the control groups. The levels of total bilirubin, direct bilirubin, indirect bilirubin, alanine aminotransferase, and alkaline phosphatase were significantly higher at day 7, day 14, and day 21 post-bile duct ligation compared with the levels in the sham group.
Conclusion:
Based on these findings, both liver and memory function were affected in the early stage of cholestasis (7 days after bile duct ligation), while learning and locomotor activity were impaired at 21 days after bile duct ligation following the progression of cholestasis.
PMCID: PMC3952346  PMID: 24639608
cholestasis; passive avoidance; locomotor activity; BDL; rat
12.  Patients’ Adherence to Anti-Diabetic Medications in a Hospital at Ajman, UAE 
Background:
Anti-diabetic medications are integral for glycemic control in diabetes. Non-adherence to drugs can alter blood glucose levels, resulting in complications. Adherence to anti-diabetic medications reported by patients and the factors associated with medication adherence among adult patients with diabetes mellitus were explored.
Methods:
This cross-sectional study was carried out among patients with type II diabetes mellitus attending the Internal Medicine Department of a hospital in the United Arab Emirates. Consecutive patients were selected, and data regarding their medication adherence were collected using a questionnaire. Data analysis was carried out using SPSS-20. The chi-square test was performed to examine the associations between categorical variables; a two-sided P Value < 0.05 was considered significant.
Results:
A total of 132 patients participated in the study (63 males; 69 females). The mean age (standard deviation) of the respondents was 54 years (SD 10.2). The self-reported adherence rate to anti-diabetic drugs was 84%. The most common reason for non-adherence was forgetfulness, and the adherence rate was similar in both genders. Patients with Bachelor’s and Master’s degree reported greater adherence rate to anti-diabetic medication in comparison to the secondary school educated.
Conclusion:
The self-reported adherence rate to anti-diabetic medications was 84%, and forgetfulness was the most common reason for non-adherence. Future studies on strategies to improve adherence rate should be considered.
PMCID: PMC3952347  PMID: 24639611
anti-diabetic drugs; compliance; diabetes mellitus; patient-physician relationship; patient adherence
13.  Effects of Bilberry on Deoxyribonucleic Acid Damage and Oxidant-Antioxidant Balance in the Lens, Induced by Ultraviolet Radiation 
Background:
This study investigated the possible protective effects of bilberry extract after exposing rat eyes to ultraviolet-B (UV-B) radiation.
Methods:
Four groups of rats were included in this study, each consisting of 10 Wistar rats. The first group acted as the control, and the second group was exposed to UV-B, 5 KJ/m2 (λm = 300 nm), for 15 minutes. The third group was orally administered bilberry extract (160 mg twice per day) for two weeks before exposure to the UV-B, while the fourth group was administered the same dose of bilberry extract for two weeks before euthanisation. A comet assay was used to examine DNA damage, while the malondialdehyde (MDA) level and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT), activities were measured in the lens.
Results:
After exposing the rats to UV-B radiation, the mean percentage tail DNA and tail moment were significantly increased (P < 0.001) when compared to the control group. In the same context, the lens tissue MDA levels and CAT activity were also significantly increased (P < 0.001). The supplementation of the bilberry extract was found to improve the comet assay parameters and enzymatic activity of the rat lens tissue.
Conclusion:
The administration of bilberry led to a decrease in the oxidative stress in the lens tissues and DNA damage induced by UV-B radiation in the lenses of Wistar rats.
PMCID: PMC3952348  PMID: 24639607
ultraviolet; rat; lens; comet assay; bilberry; malondialdehyde
14.  A Simple, Safe, and Effective Surgical Technique for The Treatment of Post-Traumatic Parotid Sialocoele 
Post-traumatic parotid sialocoele is a subcutaneous extravasation of saliva from the parotid gland secondary to traumatic disruption of its duct or parenchyma. Currently, there is no consensus regarding the best therapy for parotid sialocoele, as it is resistant to conservative management. The present paper puts forward a relatively simple, safe and effective technique for the treatment of parotid sialocoele, specifically a peroral drainage technique. The results justify our recommendation to use this approach for the treatment of sialocoele.
PMCID: PMC3952349  PMID: 24639617
trauma; parotid; surgery; drainage; salivary duct
15.  Malignant Mixed Epithelial Tumour of Ovary-Serous Papillary Cystadenocarcinoma and Transitional Cell Carcinoma with Tubo-Ovarian Torsion: A Rare Tumour with Rare Presentation 
Ovarian torsion can be associated with various pathophysiological factors. Most commonly, benign epithelial ovarian tumours present with torsion. We present an unusual case of mixed malignant epithelial ovarian tumour with a predominant component of high-grade serous cystadenocarcinoma (85%) and transitional cell carcinoma (TCC) (15%) in a patient who presented with acute lower abdomen. The tumour was associated with tubo-ovarian torsion.
PMCID: PMC3957347  PMID: 24643255
malignant epithelial neoplasms; torsion abnormality; acute abdomen; serous carcinoma; transitional cell carcinoma
16.  Purification of an IgA Monoclonal Antibody Specific for the Acr Protein of Mycobacterium tuberculosis by Immunoaffinity Chromatography 
Background:
A monoclonal antibody (mAb) of the IgA isotype, designated TBA61, is specific for the Acr protein of Mycobacterium tuberculosis (MTB). TBA61 has been used in studies exploring protection against tuberculosis (TB), and its efficacy has been proven using different challenge models. To purify the mouse IgA isotype, a combination of methods, such as globulin precipitation, ion exchange, and gel filtration, is usually required to achieve a satisfactory degree of purity.
Methods:
To minimise the number of chromatographic steps, we proposed to employ immunoaffinity chromatography using the Acr protein of MTB as a specific ligand for this mAb. For this purpose, the HspX gene was cloned and expressed in Escherichia coli, and recombinant Acr (rAcr) was coupled to a cyanogen bromide-activated Sepharose 4B matrix, which was used to purify TBA61 mAb from ascites produced in mice in a single step.
Results:
The recovery from the purification procedure was 1.46 mg per mL of ascites. Analysis by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and western blot showed a high purity. The purified mAb retained its reactivity against the Acr protein based on enzyme-linked immunosorbent assay (ELISA) and western blot.
Conclusion:
The purification method used is rapid, simple, and specific and can be easily scaled up.
PMCID: PMC3957348  PMID: 24643305
Mycobacterium tuberculosis; IgA; monoclonal antibody; Acr protein; affinity; chromatography
17.  Assessment of Nutrient Intake in Cleft Lip and Palate Children After Surgical Correction 
This research aimed to compare the nutrient intake of children with cleft lip and palate (CLP) with that of normal children (without CLP) in the same age groups. The study was conducted at the School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia. A total of 139 children, of both sexes, from two to six years of age, either with CLP (40 children) or without CLP (99 children), were selected. The CLP and non-CLP children were grouped according to age, which is a key determinant of nutrient intake. Children in subgroup I were between the ages of 2 and 4 years, the group comprising 48 normal children of mean age 39.85 months (SD 7.1), and 20 CLP children of mean age 37.05 months (SD 5.9). Children in subgroup II were those over 4 years and up to 6 years old, and the group comprised 51 normal children, of mean age 64.16 months (SD 7.9), and 20 CLP children of mean age 56.75 months (SD 9.9). A comparative cross-sectional study was conducted to evaluate nutrient intake in subgroups I and II, using a 24 hours diet recall method. The nutrient intake of CLP children was shown to have no significant differences from that of normal children. A comparison of intake per day with Recommended Dietary Allowances (RDA) for Malaysian children showed that the consumption of nutrients was inadequate in both the normal and CLP children, in both age sub-groups.
PMCID: PMC3957349  PMID: 24643339
cleft lip; cleft palate; growth; nutrition
18.  Functional Magnetic Resonance Imaging (fMRI) Neurofeedback: Implementations and Applications 
Neurofeedback (NFB) allows subjects to learn how to volitionally influence the neuronal activation in the brain by employing real-time neural activity as feedback. NFB has already been performed with electroencephalography (EEG) since the 1970s. Functional MRI (fMRI), offering a higher spatial resolution, has further increased the spatial specificity. In this paper, we briefly outline the general principles behind NFB, the implementation of fMRI-NFB studies, the feasibility of fMRI-NFB, and the application of NFB as a supplementary therapy tool.
PMCID: PMC3957350  PMID: 24643368
fMRI; learning; neurofeedback; self-regulation
19.  Necrotizing Fasciitis on the Right Side of the Neck with Internal Jugular Vein Thrombophlebitis and Septic Emboli: A Case of Lemierre’s-Like Syndrome 
Lemierre’s syndrome (LS) is a rare life-threatening infective condition typically starting with an oropharyngeal infection causing thrombophlebitis and metastatic abscesses. The most common aetiology of LS is Fusobacterium necrophorum; however, it can also occur after infection with other organisms. LS mainly affects young healthy adults. The initial infection site can be in the head and neck or in the abdomen. The morbidity rate of this disease is high despite aggressive treatments. In this article, we report a 63-year-old male patient with uncontrolled diabetes mellitus, presenting with Klebsiella pneumoniae infection-induced necrotizing fasciitis on the right side of the neck, leading to LS.
PMCID: PMC3957351  PMID: 24643401
necrotizing fasciitis; Lemierre syndrome; Fusobacterium necrophorum; Klebsiella pneumoniae
20.  Factors Associated with the Outcome of Open Tibial Fractures 
Background:
Although open tibial fractures are common in Malaysia, the outcomes for these patients have not been evaluated in the literature. This retrospective study was conducted to examine the factors associated with infection and non-union in open tibial fractures managed at Hospital Tengku Ampuan Afzan (HTAA), Kuantan, in 2009.
Methods:
From 1 January until 31 December 2009, the Department of Orthopaedics of HTAA managed 58 patients with open tibial fracture who had a minimum of a one year follow-up period. The median age was 24.5 years (range: 4 to 72 years). The open tibial fractures were graded using the Gustilo open fracture classification as follows: 4 grade I, 21 grade II, 24 grade IIIA and 9 grade IIIB. All open fractures were subjected to a standard treatment protocol at HTAA, which includes the use of prophylactic antibiotics, emergency debridement, fracture stabilisation, wound coverage, and bone reconstruction when required. The mean time from injury to the initial debridement was 29.7 hours (range: 13 to 216 hours).
Results:
Seventeen (29%) cases were complicated by infection, and 10 patients (17%) developed non-union. The grade of the open fracture was significantly associated with infection, and age and the time interval between the injury and the initial wound debridement were significantly associated with non-union.
Conclusion:
The high rates of infection and non-union, particularly in severe open fractures, indicate that there is a need to improve the management of open tibial fractures treated at HTAA. The time to initial debridement is an important factor that can be readily amended to improve the outcome. Further studies with larger sample sizes are likely needed to replicate and confirm our findings.
PMCID: PMC3957352  PMID: 24643115
assessment; case management; fractures; open; patient outcome; tibia
21.  Effects of the Aqueous Extract of Anethum graveolens Leaves on Seizure Induced by Pentylenetetrazole in Mice 
Background:
In this study, the aqueous extract of Anethum graveolens (dill) leaves was studied for its effects on treating convulsions and epilepsy, by using a pentylenetetrazole (PTZ) kindling model. The evaluated plant has a traditional medical reputation for profound anticonvulsant activities, additionally, dill has been claimed to exhibit anti-inflammatory and analgesic properties.
Methods:
For the PTZ kindling induction, mice were given a dose of PTZ (37 mg/kg, intraperitoneally) every other day, and seizure stages were precisely recorded. During and after kindling, the effects of the non-toxic doses of the aqueous extracts (100, 250, and 400 mg/kg) on seizure latency in stage 2 (S2L), seizure latency in stage 4 (S4L), and seizure duration in stage 5 (S5D) were measured.
Results:
The aqueous extract of dill leaves had a noticeable anticonvulsant effect. The 400 mg/kg dose of the extract sample decreased with S5D (P < 0.05), and increased with S2L and S4L significantly (P < 0.05 and P < 0.01, respectively).
Conclusion:
The obtained data shows that the aqueous extract possesses anticonvulsant activity against seizure induced by PTZ. The presence of anticonvulsant compounds in this medicinal herb suggests further activity and guided fractionation studies in order to introduce this plant as a valuable source of anticonvulsant agents.
PMCID: PMC3957353  PMID: 24643194
Anethum graveolens; anticonvulsant; kindling; mice; pentylenetetrazole
22.  Hepatomegaly and Periportal Oedema of the Liver in a Patient with Eosinophilic Gastroenteritis 
Periportal halos are an uncommon finding on computerised tomography (CT) of the liver. Here, reported a case of periportal halos and hepatomegaly in a patient with eosinophilic gastroenteritis. A 49-year-old male presented with a six week history of right lower quadrant pain and diarrhoea. A CT of the abdomen showed hepatomegaly and multiple hypodense periportal halos around the patent portal veins consistent with periportal oedema. A colonoscopy showed normal looking mucosa in the colon and terminal ileum. Blind biopsies taken throughout the terminal ileum and colon showed increased numbers of eosinophils (more than 25 per high-power field) consistent with eosinophilic gastroenteritis. A liver biopsy showed minimal non-specific chronic inflammatory infiltrates and eosinophils in the portal tracts with ductular proliferation. In conclusion, eosinophilic gastroenteritis should be considered in patients presenting with periportal halos, hepatomegaly, and diarrhoea.
PMCID: PMC3957354  PMID: 24643224
periportal; oedema; hepatomegaly; eosinophilic gastroenteritis; diarrhoea; corticosteroid
23.  Diagnostic Accuracy of the Quantitative C-Reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in Urinary Tract Infections among Infants and Children 
Objectives:
The aim of this study was to evaluate the diagnostic accuracy of the quantitative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count in urinary tract infections (UTI) among hospitalised infants and children in Qazvin, Iran.
Methods:
This cross-sectional study was conducted on 127 hospitalised children ranging in age from 2 months to 12 years old 31.79 months (SD 30.73) who were suspected of having a UTI and who did not receive antibiotics prior to being seen at a Qazvin teaching children’s hospital between 2005 and 2006. A urine analysis (U/A) and urine culture (U/C) were performed. The blood was taken for CRP, ESR and WBC analyses. U/C has been considered the gold standard test for a UTI and dimercaptosuccinic acid renal scintigraphy (DMSA) as the gold standard for an upper UTI (pyelonephritis). These tests were used to determine the diagnostic accuracy, which is represented as the percent of correct results.
Results:
Within the study population, 72 patients (56.7%) were younger than two years old 9.86 months (SD 4.56) and 55 (43.3%) were older than two years old 63.58 months (SD 30.96). One hundred and two patients (80.3%) were female. There were 100 cases that had a positive U/C. Of the patients with a positive U/C, 81 had pyuria (WBC more than 5/hpf), 71 had a peripheral WBC count of more than 10 000 /mL, 95 had a CRP of more than 10 mg/L and 82 had an ESR > 10 mm/h. The sensitivity and specificity as well as the positive and negative predictive values and the accuracy of CRP when using U/C as the gold standard were, respectively, 96%, 11.1%, 80.2%, 50%, and 78%; when using ESR as the gold standard were, respectively, 55%, 40%, 77.6%, 17.2%, and 52%; and when using WBC counts as the gold standard were, respectively, 69%, 52%, 86.6%, 35.6%, and 65%. The accuracy of CRP, ESR and WBC counts when considering the DMSA as the gold standard were 58.3%, 62.8%, and 64.5%, respectively.
Conclusion:
Although acute phase reactants can help in the diagnosis of a UTI, they are not pathognomonic. CRP, ESR and WBC were neither completely sensitive nor specific for detecting a UTI and its localisation site in Iranian children. Therefore, in a country where advanced clinical diagnostic tests are available, the advanced test should be used in conjunction with CRP, ESR and WBC analyses. Finally, a combination of laboratory tests along with history and exact clinical examination are needed for the diagnosis of a UTI and its localisation site.
PMCID: PMC3957355  PMID: 24643248
children; DMSA renal scintigraphy; erythrocyte sedimentation rate; Urinary tract infection; quantitative C-reactive protein
25.  Pure Red Cell Aplasia Following Thymothymectomy: A Case Report 
Thymoma, a rare epithelial neoplasm, is the most common anterior-superior mediastinal tumour. Thymoma can occur sporadically or in association with other conditions, such as myasthenia gravis, pure red cell aplasia (PRCA), and hypogammaglobulinemia. Only 5% of thymoma cases develop PRCA; however, 10–50% of patients presenting with PRCA have an associated spindle cell type thymoma. Thymoma complicated by PRCA is associated with a poor outcome. We report the case of a 38-year-old female who presented with chest pain, and was diagnosed with an anterior mediastinal mass. A thymectomy was performed, and histopathological examination revealed mixed thymoma; two months later, the patient developed PRCA. The present case reinforces the need for clinicians to be vigilant with thymoma patients, even following thymectomy.
PMCID: PMC3957357  PMID: 24643295
erythropoiesis; mediastinum; pure red cell aplasia; thymoma

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