Massoud Hajia; Amir Sohrabi
Abstract
Clinical manifestations of the brucellosis may show extensive appearance because of its wide signs and symptoms. Patients with brucellosis are usually symptomatically treated by using different antibiotics at private clinics due to misdiagnosis of clinical laboratory findings specially those chronic ...
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Clinical manifestations of the brucellosis may show extensive appearance because of its wide signs and symptoms. Patients with brucellosis are usually symptomatically treated by using different antibiotics at private clinics due to misdiagnosis of clinical laboratory findings specially those chronic forms. These subjects will have been hospitalized with a complicated form of signs after changing a few therapies (1). At this time, classical methods such as culture based and serological procedures could not alone meet of clinicians’ demands. Many researchers have been being tried to introduce an alternative method better in accuracy, reliability and efficiency aspects. However, most reported comparison studies were not able to present desired results. There are not any significant points in existence of various and even contradictory results in laboratory interpretation reports. Those patients with recent brucellosis involvement or acute disease are better diagnosed than those hospitalized or chronic cases. Unfortunately, it is being observed the most researchers are not attending the patient clinical infectious form. Obviously, in-patients have more problematical conditions that results to have lower sensitivity rate in some test or even different from each other. Unfortunately, this concern has not been noticed in the majority of molecular epidemiology studies. Analyzed results of various tests are not fully in agreement with each other in these reports, confirming each test is better suited for some specific clinical conditions (2). Another important problem is applying home brew protocols in all comparative studies. This type of non-commercial diagnostic protocol are being surprisingly applied in most small Iranian clinical laboratories. These assays have been being followed from some reported papers without any proper optimization experiments or exact clinical trial specifically for Iranian populations, particularly when several of the effective parameters in the optimization may not be well reflected in these released reports. Some of them for proper optimization and standardization are mentioned in other studies (3). Proper selecting sampling is additional problems. Serum specimens would not be preferred samples since Brucella spp. agents are intracellular which is integrated in PMN cells. Serum specimens may give positive results, but in those has high antibody titer or acute cases. Although it is used as applied specimens instead of peripheral anti-coagulated blood (4). The chance of the recovery Brucella spp. DNA is obviously reduced in those chronic and complicated subjects. In addition, sampling from patients undergoing treatment may have low positive predictive value results (5,6). It would seem international approved extraction method accompanied with internal control as control the DNA isolation procedure and to check for possible PCR inhibition should be used in molecular diagnostic settings (4,7). Finally the last point, various pathogenic Brucella species involve in many countries. At present, we have no significant documentary reports in frequency rate of Brucella spp. in our community. Some reports represent considerable rate for B. abortus while some not. Therefore, applied protocol must be enough sensitive to detect and even differentiate at least B. abortus from B. melitensis, although some reports illustrate the presence of B. canis as well as in Iran (8).
Amir Sohrabi; Massoud Hajia
Abstract
Background: The accuracy of diagnostic assays in Human Papillomavirus (HPV) genital infection and cervical cancer has remained a clinical challenge in diagnosis. Evidence indicates that a large proportion of cervical cancer can be prevented through organized care for HPV and testing. Countries ...
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Background: The accuracy of diagnostic assays in Human Papillomavirus (HPV) genital infection and cervical cancer has remained a clinical challenge in diagnosis. Evidence indicates that a large proportion of cervical cancer can be prevented through organized care for HPV and testing. Countries with low per capita income, such as Iran and its neighbours, have no national organized program for cervical cancer screening and vaccination. The aim of this study was to review recent published papers in this region for evaluating the efficacy of released data regarding HPV genotyping system in genital infections and cervical cancer Methods: Investigating various medical search engines retrieved 46 reports, mostly after 2010, consisting of either home brew protocols or commercial technologies in this field. Results: Summarized results demonstrated that except a few cases, all reports were limited studies performed in confined populations focusing on attending patients at clinics for regular checkups. In the present study, 52.8% of papers were from Iran and the rest belonged to other countries. The rate of HPV infection was reported in the range of 0.62% to 25% in the normal population, while it varied from 18.75% to 100% in females with cervical cancer. In HPV genotyping surveys, only 26.1 % (12/46) of reports had validated and World Health Organization (WHO) proficient procedures. Also, multiple infections were not mentioned in 56.52% (25/46) of researches. Conclusions: Employing reliable genotyping methods is the best way for regular screening of cervical cancer related to HPV and precancerous diseases in females of these areas. The focus of most surveys was to come up with the best national policies for establishing a preventive program in Iran and Persian Gulf area.
