More than 14 years of clinical practice in rheumatology led the author to discover the prognostic role of anti-citrullinated protein antibody (ACPA) as well as the erosions found by MRI, in detecting the RA patients resulting in establishing a new set of criteria by revising the 1987 ACR classification-Iran Criteria for Rheumatoid Arthritis. Medical records of 243 patients at the outpatient Rheumatology Clinic of the author (private sector) were reviewed for the data on the criteria of the 1987 ACR, 2010 ACR/European League against Rheumatism (EULAR), and Iran Criteria for RA. In addition to modifying the 1987 ACR classification, Iran Criteria for RA adds some additional information to the ACR criteria (including ACPA and bony erosions detected by MRI), and any patient who satisfies 6 out of 12 points is considered as a definite RA patient. Sensitivity of the three classifications was calculated considering the clinical diagnosis by a single rheumatologist as the gold standard. A total of 63 male and 180 female patients with a mean follow-up duration of 28.24 ± 50.19 months were considered. Mean age at diagnosis and mean disease duration were 49.16 ± 15.38 years and 7.04 ± 6.87 months, respectively. The sensitivity for Iran Criteria for RA, 1987 ACR classification, and 2010 ACR/EULAR criteria were calculated as 98.4, 59.7, and 66.3%, respectively. Comparing Iran Criteria for RA with ACR and ACR/EULAR criteria, it was concluded that our newly introduced criteria is a more sensitive instrument in determining RA patients in the early stages of the disease.

BACKGROUND Stenotrophomonas maltophilia, previously named as Pseudomonas or Xanthomonas maltophilia, is an important nosocomial pathogen AIM The purpose of the present study was to investigate the prevalence of S. maltophilia in Iranian hospitals and its susceptibility to available antimicrobial agents. SETTING AND DESIGN A cross-sectional study in Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences. MATERIALS AND METHODS All blood specimens were sent to the laboratory for blood culture and biochemical analysis. One hundred samples were positive for S. maltophilia. We used disk diffusion and E-test in order to determine minimal inhibitory concentration (MIC) of ceftazidime and co-trimoxazole as the first line antibiotics for S. maltophilia. The tests were performed and interpreted according to the guidelines of Clinical Laboratory Standards Institute (CLSI). STATISTICAL ANALYSIS Chi-square test and Kappa measurement of agreement were applied as appropriate. RESULTS S. maltophilia was the most frequent pathogen (895 specimens; 38.9%) isolated from the samples which were mostly from emergency ward (780 specimens; 33.9%). Ceftazidime MIC(50) and MIC(90) were 2 and 32 μg/ml, respectively (sensitive ≤8 μg/ml and resistant ≥32 μg/ml according to CLSI guideline). MIC(50) and MIC(90) for co-trimoxazole were 0.5 and 2 μg/ml, respectively (sensitive ≤2 μg/ml and resistant ≥4 μg/ml according to CLSI guideline). CONCLUSION S. maltophilia is the most frequent pathogen in our hospital with a high susceptibility to both ceftazidime and co-trimoxazole.

This study was designed to describe clinical manifestation, treatment and outcomes in patients with sphenoid sinus mucocele presenting to Amiralam Hospital, Tehran, Iran. A review of 43280 medical records covering a period of 10 years included just 12 patients with sphenoid sinus mucocele presenting to our teaching centre. The mean age of the patients was 35 years (ranging from 19 to 52 years). Headache was the most frequent symptom in 9 of the 12 patients. Visual disorders were noted in five patients. Two patients underwent external ethmoidectomy accompanied by intranasal sphenoidotomy while transseptal sphenoidotomy was performed for five patients and five patients underwent endoscopic endonasal sphenoidotomy. Wide spectrum antibiotics were given to all the patients for 3 to 5 days in order to prevent any iatrogenic infection. All patients did well after surgery without postoperative complications. Sphenoid sinus mucocele should be considered in the differential diagnosis of cystic lesions presenting as visual disturbance. Retro-orbital headache with or without visual symptoms is a leading symptom. CT and MRI are essential in the diagnosis of sphenoid disease.

In this study, the relationship between sleep quality and type and duration of labour has been evaluated. A total of 88 pregnant women completed the Pittsburgh Sleep Questionnaire three times during their last 3 weeks of pregnancy at their prenatal visits and once postpartum. A mean score of >5 was considered as poor-quality sleep. Duration of labour, type of delivery and weight of the newborn at delivery was considered. Of the study population, 56.2% were categorised as the good-quality sleep group and 43.8% as the poor-quality sleep group. The reported sleeping time per day was 8.47±1.86 hours for the good-quality sleep group and 6.45±2.07 hours for the poor-quality sleep group. The poor-quality sleep women were 20% more likely to undergo caesarean section and had a longer labour duration. Gestational age at delivery and mean gravidity was respectively 38.53±1.17 weeks and 1.91±1.03 in the good-quality sleep group and 38.36±1.59 weeks and 1.86±1.07 in the poor-quality sleep group. Thus, it was found that women with sleep problems experience longer labour duration and are more likely to undergo a caesarean section.

Cardiovascular events are a major cause of mortality and morbidity of chronic renal failure causing 40% to 50% of all deaths in these patients. The intima-media thickness of the common carotid artery is used to predict atherosclerosis. To assess the effect of early renal transplant on the vascular atherosclerosis, we compared the common carotid intima-media thickness between dialysis and transplant patients. In a cross-sectional study, 75 kidney transplant recipients and 75 dialysis patients were assessed in a subspecialized renal and urethral diseases center from April 2008 to March 2010. Demographic characteristics, smoking history, and information on comorbid and kidney diseases were recorded through a checklist. The common carotid intima-media thickness was measured using ultrasonography. Spearman's rank correlation coefficient was used to find any correlation between duration of dialysis and intimamedia thickness. In all, 79 patients (53%) were male. The mean age (SD) of dialysis and transplant patients was 55 ± 11 and 51 ± 15 years. The 2 groups had no statistically significant sex or age differences (P >.05). Considering all patients, 54 (36%) had a history of hypertension, 30 (20%) had a history of diabetes mellitus, 15 (10%) had a history of hyperlipidemia, and 41 (27.3%) had a history of smoking. There were no significant differences between the 2 groups when these variables were considered (P >.05). The mean thickness of the common carotid intima-media was 1.2 mm (0.35 mm) in the dialysis patients, which was higher compared with 0.73 mm (0.18 mm) in the transplanted group (P <.001). There was a significant correlation between duration of dialysis and intima-media thickness (P <.001, r=0.882) in the dialysis group. Common carotid intima-media thickness in dialysis patients is significantly higher compared with kidney transplant recipients. Carotid intima-media thickness increases by prolongation of dialysis duration.

Urgent fibrogastroduodenoscopy was performed in 145 of 178 elderly and senile patients with bleedings from upper portions of the digestive tract, ulcerous bleedings being revealed in 92 of them. Surgery is thought to be the best method in cases with persistent bleedings and in the revealed during examination thrombosed vessels in the ulcer without active bleeding. In 33 patients not subjected to endoscopy the latter could have given better results of treatment.