National Research Institute Of Tuberculosis And Lung Disease Research Articles

National Research Institute of Tuberculosis and Lung Disease (NRITLD) Protocol for the Treatment of Patients with COVID-19

More than a year after the onset of the coronavirus disease pandemic in 2019, the disease remains a major global health issue. During this time, health organizations worldwide have tried to provide integrated treatment guidelines to control coronavirus disease 2019 (COVID-19) at different levels. However, due to the novel nature of the disease and the emergence of new variants, medical teams' updating medical information and drug prescribing guidelines should be given special attention. This version is an updated instruction of the National Research Institute of Tuberculosis and Lung Disease (NRITLD) in collaboration with a group of specialists from Masih Daneshvari Hospital in Tehran, Iran, which is provided to update the information of caring clinicians for the treatment and care of COVID-19 hospitalized patients.

Pulmonary manifestations in a cohort of patients with inborn errors of immunity: an 8-year follow-up study.

Inborn errors of immunity (IEIs) are a group of congenital diseases caused by genetic defects in the development and function of the immune system. The involvement of the respiratory tract is one of the most common presentations in IEIs. Overall, 117 patients with diagnosed IEIs were followed-up within 8 years at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD). Demographic, clinical, and laboratory data were collected in a questionnaire. Pulmonary function test (PFT), chest X-ray (CXR), and high-resolution computed tomography (HRCT) scans were obtained where applicable. Our study population consisted of 48 (41%) patients with predominantly antibody deficiencies (PADs), 39 (32%) patients with congenital defects of phagocytes, 14 (11.9%) patients with combined immunodeficiency (CID), and 16 (14%) patients with Mendelian susceptibility to mycobacterial diseases (MSMD). . Recurrent pneumonia was the most common manifestation, while productive cough appeared to be the most common symptom in almost all diseases. PFT showed an obstructive pattern in patients with PAD, a restrictive pattern in patients with CID, and a mixed pattern in patients with CGD. HRCT findings were consistent with bronchiectasis in most PAD patients, whereas consolidation and mediastinal lesions were more common in the other groups. Pulmonary manifestations vary among different groups of IEIs. The screening for lung complications should be performed regularly to reveal respiratory pathologies in early stages and follow-up on already existing abnormalities.

Correction to: Development of an efficient perfusion-based protocol for whole-organ decellularization of the ovine uterus as a human-sized model and in vivo application of the bioscaffolds

The original version of this article unfortunately contained a mistake. The affiliation of Fariba Ghorbani should be Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Susceptibility to mycobacterial disease due to mutations in IL-12R\u03b21 in three Iranian patients

In the last decade, autosomal recessive interleukin-12 receptor β1 (IL-12Rβ1) deficiency, the most common cause of Mendelian susceptibility to mycobacterial disease (MSMD), has been diagnosed in a few children and adults with severe tuberculosis in Iran. Here, we report three cases referred to the Immunology, Asthma and Allergy ward at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) at Masih Daneshvari Hospital from 2012 to 2017 with Mycobacterium tuberculosis and non-tuberculous mycobacteria infections due to defects in IL-12Rβ1 but with different clinical manifestations. All three were homozygous for either an IL-12Rβ1 missense or nonsense mutation that caused the IL-12Rβ1 protein not to be expressed on the cell membrane and completely abolished the cellular response to recombinant IL-12. Our findings suggest that the presence of IL-12Rβ1 deficiency should be determined in children with mycobacterial infections at least in countries with a high prevalence of parental consanguinity and in areas endemic for TB like Iran.

P3.03-053 Malignant Mesothelioma in Iranian Patients: A Study from National Institute of Tuberculosis and Lung Disease: Topic: Mesothelioma Clinical

Malignant mesothelioma (MM) is a tumor which originated from lung, chest cavity or abdomen.The close link between exposure to asbestos exposure and MM development is evident. The disease remains challenging in terms of diagnosis, staging and treatment. The aim of this study is to assess clinicopathological and outcome data of Iranian MM patients. This retrospective study with 126 eligible patients was conducted from January 2002 to February 2016 in National Research Institute of tuberculosis and Lung Disease (NRITLD), Tehran, Iran. The patients belonged to different geographical regions of Iran. Efficacy analysis included progression free survival (PFS) as primary end point. All analysis was performed by SPSS version 16. In this study, male/female ratio was of 2.07 (85/41) and mean age of 55.06± 11.03 years (range 25-80). The histologic subtypes were: epithelioid 28.6%,biphasic 7.1%,sarcomatoid 3.2%,Lymphohistiocytic 0.8%, and in 57.9% the subtype was not determined. In 2.4 % of cases defined as desmoplastic mesothelioma variation. Only, 1 patient had abdominal mesothelioma. Stage distribution was: stage I: 38%, stage II: 21.4%, stage III: 7.9% and 32.5% had stage IV. Only, for 12.7 % cases surgery was performed and 92.9 patients had been received chemotherapy. Asbestos exposure was reported in 35.7 %.Table 1Clinico-pathological data in relation to asbestos exposureExposureCI 95%Odds ratioP-valueYesNoAge <70 >7141 465 120.572-6.21.80.29Stage I,II and III IV25 2033 450.813-3.571.7050.156Histologic subtype Epitheliod Other subtypes31 1448 300.635-3.0151.3840.413Sex Female Male10 3531 470.188-10.4330.047*Response to treatment CR, PR or SD Progressive disease29 1550 200.344-1.70.7330.534* significant P value. Median of PFS was 8.6±1.08 months (CI 95%: 6.5-10.6 months). PFS was mildly longer in patents without asbestos exposure more than the other group but was not statistically significant between patents who had history of to asbestos exposure and who did not.( 8.16 vs 10.6, P=0.880) Open table in a new tab * significant P value. Median of PFS was 8.6±1.08 months (CI 95%: 6.5-10.6 months). PFS was mildly longer in patents without asbestos exposure more than the other group but was not statistically significant between patents who had history of to asbestos exposure and who did not.( 8.16 vs 10.6, P=0.880) In our study, 35.7% patients had asbestos exposure and can be described by the long latency period of the tumor. In order to improve the efficacy of MM patients, early diagnosis and effective treatment strategies will be highly expected to develop.

Features of Adolescents Tuberculosis at a Referral TB's Hospital in Tehran, Iran.

ObjectiveTo identify the pattern of the clinical, radiological, diagnostic procedures and loss to follow-up of the diagnosed cases of active tuberculosis (TB) adolescents.MethodsThis study was a retrospective analysis of the medical records of 143 adolescents aged 10 to 18 years with tuberculosis who were admitted TB wards of National Research Institute of Tuberculosis and Lung Disease (NRITLD) in Tehran, Iran, between March 2006 and March 2011.ResultsOf the 143 patients identified, 62.9% were females. Median age of the patients was 16 years. The contact source was identified in 47.5%. The most common presenting symptom was cough (86%). Isolated pulmonary TB (PTB) was detected in 113 patients (79%), 21 patients (14.7%) had extrapulmonary TB(EPTB), and 9 patients (6.3%) had PTB and EPTB. The most common site of EPTB was pleural (14%). The most common radiographic finding was infiltration (61%). Positive acid fast smears were seen in 67.6%. Positive cultures for Mycobacterium tuberculosis (M. TB) were seen in 44.7%. Positive Polymerase chain reaction (PCR) results were seen in 60%. The adolescents aged 15 to 18 years were more likely to lose weight (p=0.001), smear positive (p=0.001), culture positive (p<0.001) and have positive PCR results (p=0.009). The type of TB (p=0.017) was a significant factor influencing loss to follow-up.ConclusionsThe study has revealed that the clinical and radiological findings of TB in adolescents are combination as identified in children and adults. The TB control programs should pay more attention to prevention and treatment of TB in adolescents.

Nontuberculous mycobacterium in a tertiary tuberculosis center in Iran: Dispensation and outcome of treatment

IntroductionNontuberculous mycobacterium (NTM) has clinical and radiological manifestations that are indistinguishable from mycobacterium tuberculosis (MTB). In an endemic area for tuberculosis (TB), limited data about prevalence and outcome of treatment of these patients is available.In this study the prevalence of different types of mycobacterium and response to treatment in a tertiary referral center in Iran will be evaluated. Materials and methodAll NTM cases from 2004 to 2013 at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) in Iran were extracted from the database. All NTM patients who were treated for NTM diseases entered this study, and the outcome of treatment was evaluated. ResultsA total of 104 cases were detected. The mean age was 56.34±15.77years. Half of the patients were male. Most of the patients had a history of prior TB treatment. The most common types of NTM were Mycobacterium simiae (44 [42.3%]), Mycobacterium kansasii (18 [17.3%]), Mycobacterium abcessus (15 [14.4%]), and Mycobacterium chelonea (14 [13.5%]), respectively.The outcome of treatment was as follows: cure 61 (58.7%), failure 17 (16.3%), relapse 3 (2.9%), default 13 (12.5%) and death in 10 (9.6%) patients. ConclusionTreatment of NTM had a low cure rate despite low mortality.

Impact of diabetes mellitus on tuberculosis drug resistance in new cases of tuberculosis

Background and objectiveDiabetes mellitus (DM) has an effect on many aspects of tuberculosis (TB). The aim of this study is to determine the impact of DM on anti-tuberculosis drug resistance in new cases of TB patients. Materials and methodsA case-control study was conducted on all newly diagnosed pulmonary TB adult patients with DM as cases and without DM as controls who were hospitalized and treated at the National Research Institute of Tuberculosis and Lung Disease (NRITLD) from May 2013 to October 2013. A molecular resistance test for rapid detection of resistance to isoniazid and rifampin was done for all smear-positive TB patients. A multivariate analysis was performed to determine the impact of DM on any anti-TB drug resistance. Results45TB cases with DM and 45TB cases without DM were included. TB cases with DM were more likely to be older (61 vs. 47years, p=0.001). Two TB–DM patients had multidrug-resistant TB (MDR-TB) (4.4%) compared with zero cases of MDR-TB in the control group, and TB–DM cases were resistant to at least one drug (11.1% vs. 4.4%, p=0.43). DM remained significantly associated with any drug resistance (OR: 6.32, 95% CI: 1–40.72) in multivariate analysis. ConclusionNew TB patients with DM are at increased risk of anti-TB drug resistance. More studies are needed to confirm these results.

The Effect of Preemptive Oral Celecoxib on Pain Reduction and Opioid Consumption during Elective Herniorrhaphy

*Corresponding author: Alireza Jahangiri Fard MD , Assistant Professor of Anesthesiology, Fellowship of Cardiac Anesthesia, Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Science, Tehran, Iran; E-mail: omidjahangiri_55@yahoo.com Citation: Mahjoubifard M, Enayati H, Noori N, Mahdy S, Jahangiri Fard A (2016) The Effect of Preemptive Oral Celecoxib on Pain Reduction and Opioid Consumption during Elective Herniorrhaphy. Enliven: J Anesthesiol Crit Care Med 3(1): 001.

Factors Associated with Health-Related Quality of Life in Tuberculosis Patients Referred to the National Research Institute of Tuberculosis and Lung Disease in Tehran.

BackgroundIn tuberculosis (TB) patients, health-related quality of life (HRQoL) is significant in self-management, which in turn can be effective in therapeutic acceptance and prevention of treatment failure due to multi-drug resistant TB. This study was conducted to evaluate HRQoL and associated factors in TB patients referred to the National Research Institute of Tuberculosis and Lung Disease (NRITLD).MethodsIn this study, patients were selected from TB clinics of the NRITLD in Tehran. In addition to an Iranian version of the Short-Form Health Survey (SF-36), demographic and disease characteristic questionnaires were used for data collection. The data were then analyzed using SPSS software.ResultsTwo hundred five TB patients, with the average age of 42.33±17.64 years, participated in this study. The HRQoL scores in different domains ranged from 14.68±11.60 for role limitations due to emotional problems to 46.99±13.25 for general health perceptions. The variables of sex, marital status, education, job status, place of residence, and cigarette smoking, influenced the HRQoL scores in different dimensions.ConclusionAccording to the study findings are the important variables that influenced the HRQoL of TB patients. The consideration of its can improve the HRQoL of TB patients.

Histologic Types of Chest Wall Tumors—Nine Years’ Single Center Experience

Background: Chest wall tumors are rare and mostly malignant. More than half of the malignancies are primary and the remainder are metastatic. Many studies have reported that metastatic lesions occur with about the same frequency as primary tumor. We evaluate common histological types of chest wall tumors in a tertiary center for respiratory and thoracic diseases (National Research Institute of Tuberculosis and Lung Disease). Method: We performed a retrospective study of chest wall tumors at National Research Institute of Tuberculosis and Lung Disease (NRITLD) from April 2001 to March 2010. The pathology slides of patients were retrieved from the pathology archive of NRITLD and reviewed by two pathologists. The lesions were classified as primary or metastatic according to the relevant clinical data and imaging findings. Result: A total of 124 chest wall tumors were identified in patients with a mean age of 47.7 years (range 4-90 years). The male/female ratio was 2:1. The most commonly affected side was the right (42.7%). There were 105 malignant tumors (84.7%), out of which 49 (46.2%) were primary and 57 (53.8%) were metastatic in origin. The majority of the metastatic lesions were epithelial tumors (36/57) (63.1%). The metastatic origin was clear in 51 cases, mostly arising from the lungs (35.7%). The most common types of primary chest wall tumors were primitive neuroectodermal tumor (15/49, 30.6%), chondrosarcoma (7/49, 14.3%), and malignant fibrous histiocytoma, undifferentiated pleomorphic sarcoma (5/49, 10.2%). The most common benign tumor was lipoma (5/18, 35.7%). Conclusion: Most common tumors of chest wall in this study were malignant, mostly metastatic epithelial neoplasms.

Evaluation of the relationship between smear positivity and high-resolution CT findings in children with pulmonary tuberculosis.

SummaryBackgroundThe aim of this study is to find a relationship between the radiological manifestations of childhood tuberculosis on a high-resolution computed tomography (HRCT) and the results of sputum smear. This study aims to propose an alternative indicator of infectivity in terms of prevention of disease transmission through selective isolation policy in children whose clinical condition is highly suggestive of tuberculosis.Material/MethodsThis retrospective comparative study was performed on 95 children under 15 years of age diagnosed with tuberculosis based on both WHO criteria and positive sputum culture for mycobacterium Tuberculosis. The children were admitted for TB screening in the pediatric department of national research institute of tuberculosis and lung disease (NRITLD) between 2008–2012. Direct smear collected from sputum or gastric lavage, as well as HRCT were performed in all children prior to administration of medical therapy. Children were divided into 2 groups based on positive and negative smear results. HRCT abnormalities, as well as their anatomical distribution were compared between these 2 groups using multivariate analytic model.ResultsThe most prevalent abnormalities in the positive smear group were consolidation, tree-in-bud pattern, upper lobe nodular infiltration and cavitation. The negative smear group featured lymphadenopathy, consolidation, collapse and nodular infiltration in the upper lobe. Cavity, tree- in-bud pattern and upper lobe nodular infiltration were highly associated with smear positivity in children. Conversely, lymphadenopathy and collapse had significant association with a negative smear.ConclusionsThis study revealed that cavity, tree-in-bud and upper lobe nodular infiltration has significant association with smear positivity in childhood tuberculosis. On the other hand, lymphadenopathy and collapse were closely associated with smear negativity in this age group. It was also demonstrated that children with a positive smear most likely presented with radiological features of post primary tuberculosis, while the negative smear group most often manifested with primary tuberculosis.

Clinical and Radiographic Findings of Pulmonary Tuberculosis in Infants

literature. Objectives: This study defines the clinical and radiological features of tuberculosis in infants less than one year of age. Materials and Methods: The medical records were reviewed for all infants aging 12 months or less with diagnosis of tuberculosis at TB wards of National Research Institute of Tuberculosis and Lung Disease (N.R.I.T.L.D.) in Tehran, Iran between 2006 - 2012 retrospectively. Results: Nine infants with a median age of eight months were identified, all of whom had endothoracic Tuberculosis. The cause of medical evaluation was the unset of symptom in five infants and close contact with infected patients in four. Common symptoms and signs included cough in four, Night sweat in three and Crackles in two patients. Chest X-ray showed consolidation in three, nodular lesions in three, consolidation and ground glass in one, mediastinal bulging in one. Chest CT scan revealed consolidation in three, disseminated pulmonary nodules in one, tiny nodules in two, ground glass lesion in two, right Para-tracheal and subcarinal lymphadenopathies in two, pre-bronchial thickening in one and bronchiectasis in one. Culture was obtained from all of the patients and was positive in one. All infants promptly responded to the treatment. No complications and deaths occurred. Conclusions: Pulmonary tuberculosis predominates in infants. Prompt diagnosis and treatment seem to reduce morbidity and mortality in this age group. Chest CT may be supportive in the diagnosis of infants with characteristic lymphadenopathy.

Idiopathic pulmonary fibrosis in a referral center in Iran: are patients developing the disease at a younger age?

The incidence of idiopathic pulmonary fibrosis (IPF) appears to be increasing. In the western literature, the average age of presentation is in the seventh decade of life while it has been reported to be earlier in the Middle East and India. Given that a paucity of epidemiological data exists in Iran, we sought to describe the clinical pattern and course of the disease at a large Iranian referral center. A retrospective review was conducted of 132 patients diagnosed with IPF at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) in Tehran, Iran from 1988 through 2008. Data were collected from the medical records which consisted of demographics, clinical history, laboratory tests, pulmonary function tests (PFT), radiographic and pathology findings, treatment, and outcomes of the disease. The mean age at diagnosis was 56.6 years (95% CI: 53.8 - 59.4) with no significant sex predilection. Common presenting symptoms included dyspnea and cough, which occurred for a mean period of 21 months prior to diagnosis. Common signs included end-inspiratory crackles and digital clubbing, which were found in 85.6% and 55.3% of the patients, respectively. Radiographically, reticular and reticulonodular opacities were seen in 47.3% and 20.9% of the patients, respectively on high resolution computed tomography (HRCT). In patients who underwent lung biopsy, diffuse interstitial fibrosis was seen in 91.1%. The mean follow-up time for all patients was 32.8 months (95% CI: 23.2 - 42.4, range: 1 - 257 months). There were 16 patients who died during the study period. The mean age of death was 56.8 years (95% CI: 46.2 - 67.4), which is significantly lower than the life expectancy in Iran (P-value: 0.017). The mean survival time for patients who died was 1.1 years (95% CI: 0.5 - 1.7) after diagnosis. The one- and three- year overall survival rates for all patients were 88% and 79%, respectively. The clinical characteristics of IPF in Iran are similar to those in the western literature. However, Iranian patients appear to be developing the disease a decade earlier than western patients.

Risk factors affecting the survival rate in patients with symptomatic pericardial effusion undergoing surgical intervention

The optimal management and treatment of pericardial effusion are still controversial. There is limited data related to the risk factors affecting survival in these patients. The aim of this study was to determine the risk factors affecting the survival rate of patients with symptomatic pericardial effusion who underwent surgical interventions. From 2004 to 2011, we retrospectively analysed 153 patients who underwent subxiphoid pericardial window as their surgical intervention to drain pericardial effusions at the National Research Institute of Tuberculosis and Lung diseases (NRITLD). To determine the effects of risk factors on survival rate, demographic data, clinical records, echocardiographic data, computed tomographic and cytopathological findings and also operative information of patients were recorded. Patients were followed annually until the last clinical follow-up (August 2011). To determine the prognostic factors affecting survival, both univariate analysis and multivariate Cox proportional hazards model were utilized. There were 89 men and 64 women with a mean age of 50.3 ± 15.5 years. The most prevalent symptom was dyspnoea. Concurrent malignancies were present in 66 patients. Lungs were the most prevalent primary site for malignancy. The median duration of follow-up was 15 (range 1-85 months). Six-month, 1-year and 18-month survival rates were 85.6, 61.4 and 36.6%, respectively. In a multivariate analysis, positive history of lung cancer (hazard ratio [HR] 2.894, 95% confidence interval [CI] 1.362-6.147, P = 0.006) or other organ cancers (HR 2.315, 95% CI 1.009-50311, P = 0.048), presence of a mass in the computed tomography (HR 1.985, 95% CI 1.100-3.581, P = 0.023), and echocardiographic findings compatible with tamponade (HR 1.745, 95% CI 1.048-2.90 P = 0.032) were the three independent predictors of postoperative death. In the surgical management of pericardial effusion, patients with underlying malignant disease, especially with lung cancer, patients with a detectable invasion of thorax in computed tomography and those with positive echocardiographic findings compatible with tamponade have a poor survival. Therefore, minimally invasive therapies could be considered as a more acceptable alternative for these high-risk patients.

Wells’ prediction rules for pulmonary embolism

Pulmonary embolism is major cause of hospital death. Clinical prediction rules such as Wells' prediction rules can help in selection of at-risk patients who need further testing for pulmonary embolism. We evaluated the usefulness of such criteria for detection of patients with diagnosed pulmonary embolism. Patients enrolled in National Research Institute of Tuberculosis and Lung Disease (NRITLD) deep venous thrombosis (DVT) registry were evaluated and those with objective data about presence or absence of pulmonary embolism were selected for this study. Diagnosis of pulmonary embolism was based on computed tomography pulmonary angiography (CTPA). We calculated the embolic burden in those with CTPA-confirmed pulmonary embolism. Eighty-six patients entered the study (58 males, 28 females, mean age = 54.39 ± 1.74 years). Fifty-four cases had coexisting pulmonary embolism (embolic burden score: 10.77 ± 1.181). Embolic burden score was correlated to presence of massive pulmonary embolism (Pearson rho: 0.43, P = 0.002). There was no association between Wells' pulmonary embolism score and the occurrence of pulmonary embolism (Spearman's rho: 0.085, P = 0.51). Dividing the patients into two, or three, risk groups according to Wells' model did not reveal an association with occurrence of pulmonary embolism either (P = 0.99 and P = 0.261, respectively). Tachycardia and hemoptysis were the only parameters from the Wells' pulmonary embolism score correlated to presence of pulmonary embolism (Spearman's rho: 0.373, P < 0.000 and Spearman's rho: 0.297, P = 0.005, correspondingly). Wells' pulmonary embolism score could not predict the occurrence of pulmonary embolism in DVT patients suspected of having coexisting pulmonary embolism. Until further studies shed light on this patient subset, overreliance on Wells' prediction rules as the solo decision making tool should be cautioned.

Adenosine Deaminase Level as an Indicator for Differentiating Between Active Pulmonary Tuberculosis Infection and Other Pulmonary Infections

Background: In spite of recent advents, and novel improvements in the diagnosis and treatment of pulmonary tuberculosis (TB), definitive diagnosis of pulmonary TB in children is problematic. Therefore, measurement of the serum level of adenosine deaminase (ADA) was later introduced as a helpful marker for the diagnosis of TB. Objectives: The purpose of this study was to determine the usefulness of the ADA testin the diagnosis of pulmonary TB, and compare enzyme activity between patients with pulmonary TB and those with other pulmonary infections. The sampling strategy was randomized, and the design of study was case-control diagnostic descriptive, we used IBM SPSS V-16.0.2 software for analyzing our data. Patients and Methods: This study was performed at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) in Tehran, IR Iran. In all, 49 children, divided into 3 groups, were examined. Of these, 22 had pulmonary TB, 17 had other pulmonary infections, and the remaining 10 children were normal and were assigned to the control group. Results: Serum ADA levels were higher in the pulmonary TB patients than in the control group (P < 0.05), however, these levels did not differ significantly between TB patients and patients with other pulmonary infections (P = 0.391). Our evaluation revealed that ADA level in TB patients with a positive smear of gastric washing were higher than those in patients with a negative smear (P = 0.006). Conclusions: Similar to the other studies, this study showed higher serum ADA level in pulmonary TB patients than in normal individuals. However, ADA was not found to be a suitable marker for differentiating between pulmonary TB and other pulmonary infections.

Adenosine Deaminase Level as an Indicator for Differentiating Between Active Pulmonary Tuberculosis Infection and Other Pulmonary Infections

Background: In spite of recent advents, and novel improvements in the diagnosis and treatment of pulmonary tuberculosis (TB), definitive diagnosis of pulmonary TB in children is problematic. Therefore, measurement of the serum level of adenosine deaminase (ADA) was later introduced as a helpful marker for the diagnosis of TB. Objectives: The purpose of this study was to determine the usefulness of the ADA testin the diagnosis of pulmonary TB, and compare enzyme activity between patients with pulmonary TB and those with other pulmonary infections. The sampling strategy was randomized, and the design of study was case-control diagnostic descriptive, we used IBM SPSS V-16.0.2 software for analyzing our data. Patients and Methods: This study was performed at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) in Tehran, IR Iran. In all, 49 children, divided into 3 groups, were examined. Of these, 22 had pulmonary TB, 17 had other pulmonary infections, and the remaining 10 children were normal and were assigned to the control group. Results: Serum ADA levels were higher in the pulmonary TB patients than in the control group (P < 0.05), however, these levels did not differ significantly between TB patients and patients with other pulmonary infections (P = 0.391). Our evaluation revealed that ADA level in TB patients with a positive smear of gastric washing were higher than those in patients with a negative smear (P = 0.006). Conclusions: Similar to the other studies, this study showed higher serum ADA level in pulmonary TB patients than in normal individuals. However, ADA was not found to be a suitable marker for differentiating between pulmonary TB and other pulmonary infections.

Clinical and radiological aspects of chronic granulomatous disease in children: a case series from Iran.

Chronic granulomatous disease (CGD) is a rare disorder of phagocytes, predisposes patients to bacterial and fungal infections. The main purpose of this study was to determine the clinical, radiological, pathological features, outcome and response to treatment of children with CGD. Thirteen patients with CGD, who had been referred to National Research Institute of Tuberculosis and Lung Disease (NRITLD), were reviewed during a 6 year period (1999-2005). There were 10 (76%) male and 3(24%) female cases. The median age of the patients was 9 years (1 month-12 years). Family history of CGD was reported by 7 patients. The median diagnostic age was 8 years, with a diagnostic delay of 4.5 years. The most common manifestations of CGD were pulmonary infections and skin involvement, followed by generalized lymphadenopathy. The most common radiological findings were multiple lymphadenopathy in mediastinal region and fibrotic changes in lung fields. Two patients died of pulmonary infections. Based on the results of this research, immunologic evaluations especially evaluation for CGD is highly recommended in children suffering from recurrent pulmonary infections, cutaneous or hepatic abscesses, or infections caused by uncommon pathogens. Early diagnosis and prophylactic treatment both, prevent further development of the lesions, irreversible complications and decreasing mortality and morbidity rates in children suffering from CGD.