MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2009 | Volume:52 | Issue:3|Papers Count:13

Introduction: b-thalassemia Major is one of the most common diseases in Iran especially in Golestan province. Blood transfusion has many important complications such as endocrine disorders & Hypothyriodism which can result in disability & untimely mortality. This study was designed to determine the association between Hypothyroidism & serum level of ferritin in these patients. Materials and Methods: This study was performed on all patients in thalassemia center of Gorgan (n=185) with age range of 1-37 years. During five years, level of ferritin & T3, T4, TSH were measured every three & 12 months respectively. Data were analyzed using SPSS software.Results: Thirty patients had hypothyroidism. Mean age was 17.8 years & male/female ratio was 1. Five patients were under the age of 10. The average level of ferritin at the onset of complication was 2528.400±2157.300 ng/ml. Serum level of ferritin in hypothyroidism, had shown a significant difference in comparison to non-hypothyroid patients (p<0.05).Conclusion: This study showed that to prevent hypothyroidism in major thalassemia, we could start clinical & para-clinical studies¸ such as checking serum level of ferritin. Although endocrine abnormalities are usually sought in patients over 10 years of age, we recommend starting the endocrine screening at age 5 since we had 5 patients under the age of ten with these abnormalities.

Introduction: Drug abuse is a major health problem in the Middle East countries such as Iran. Drug dealers may add lead to increase the weight of opium. Several reports have found lead poisoning symptoms in opium dependent patients, which are usually non specific. To the extent of our knowledge, there is no comparative study about blood lead level (BLL) in opium dependent patients with healthy control group. Therefore, the main purpose of this study was comparison of serum lead level in oral opium dependent men with control group.Materials and Methods: In this study, BLL of forty- four subjects in two patient and control groups was evaluated. The patient group (22 cases) comprised patients who used oral opium. The control group (22 cases) was matched with patient group in age and sex with the mean age of 38.8±6.7. BLL was assessed immediately, using atomic absorption spectrophotometer.Results: BLL in the patient group had a range of 7.2 to 69.9 mg/dl (21.9±13.2). In the healthy control group, BLL was between 4.1 and 17.4 mg/dl (8.6±3.5). The mean difference of two groups (t= 4.56) was statistically significant (p<0.0001). In the patient group, BLL had a significant correlation with the amount of opium consumption (r= 0.65, p<0.01). However, there was no such correlation with the length of experience of opium consumption in the patient group. Conclusion: It would be concluded that the opium dependent patients have elevated BLL compared to the healthy control. Therefore, screening for blood lead concentration is helpful for the opium dependent patients, especially with non-specific symptoms.

Introduction: Influenza virus H9N2 Low Pathogenicity of the viruses that are causing the disease in 1999, two 1 and 4-year-old girl in Hong Kong. Although influenza A H9N2 subtype virus is considered as widely spread low pathogen in poultry, however there are a few reports of human infection by this virus. This study was conducted to evaluate if such infection in human related by Poultry Farm Industries i.e. workers of slaughter house, poultry farms, and poultry clinics in Iran has occurred or not. Materials and Methods: In this study, sera and swabs–nasal and throat- were collected from workers of slaughter houses, poultry farms, Razi institute. To prevent false positive and negative results in HI test the sera were treated by trypsin-periodate and concentrated RBC respectively. RT-PCR was accomplished seeking HA and NP genes of H9N2 subtype influenza viruses.Results: Of 148 sera HI titers, two and 17 samples were 1/160 and 1/40 respectively for antibody against H9N2 influenza virus. The higher titers belonged to slaughter house workers. No viruses were detected in RT-PCR.Conclusion: The positive sera for antibody against H9N2 influenza virus showed a changing tendency of these viruses toward infecting human tracheal epithelia. However the highest titer in slaughter house worker showed the need to close contact with poultry and their feeces for infection to be occurred. It means that the virus needs more circulation in human population to be adapted as true human influenza virus.

Introduction: According to the reports of World Health Organization (WHO), Hemophilus Influenza type b (HIB) is the most common cause of pediatric bacterial meningitis in Eastern Mediterranean Region of WHO, but in Mashhad as in most cities of Iran we haven’t seen it frequently. The aim of this study was to declare the real role of HIB in pediatric meningitis in Mashhad Materials and Methods: In winter 2005, after improving our techniques in sampling, transfer and processing of (CSF) and with adding Latex agglutination test to our diagnostic methods, we prospectively analyzed all of the CSF samples of Mashhad kids in a single Lab.Results: A total of 230 CSF samples were obtained during the study period (Dec-25- 2005 to My-23-2006, 140 days). Pleocytosis of CSF (and thus meningitis) was observed in 98 (42.4%) of these samples, among them there were 9 definite cases (9.18%) of bacterial meningitis (HIB: 4, Pneumococcus: 3 Meningococcus: 1 Citrobacter: 1). The estimated incidence of HIB meningitis in children younger than 5 years was 2.31/100000 persons/year and the estimated number of Lumbar Punctures in them was 106.59/100000 persons/year.Conclusion: HIB is the most common cause of Bacterial Meningitis in children in Mashhad, but like other Iranian reports the Incidence of HIB meningitis is much lower than the expected level. The number of Lumbar Punctures per 100000 children per year, and the rate of positive CSF cultures is also unacceptably lower than WHO standards.

Introduction: The First Cerebral vein thrombosis was reported in 1825. Early diagnosis is very important, because early treatment can prevent mortality in most eases. Also, cerebral vein thrombosis is preventable by finding the underlying etiology. True incidence of cerebral vein thrombosis is not predicative.Materials and Methods: This descriptive study was performed from 2005 through 2006 on patients referred to Qaem Hospital neurological emergency ward. All of the patients with clinical feature of ICP rising were evaluated and underwent CT scan and MRI of brain. In cases suspicious to cerebral vein thrombosis, the disease was actually diagnosed with MR venography of brain, after discharge Patients were followed up every week for 3 weeks in neurological clinic of Qaem Hospital.Results: From 20 evaluated patients, 70% were female and 30% were male, in which the ratio of F/M was 3/2. Patients mean age was 30 year. The most clinical feature was headache. Underlying etiologies in above patients were: OCP consumption, post partum period, media otitis, nephrotic syndrome and Crystal abuse. In MRI and MRV assays of studied patients, 20% had superior sagital sinus, 10% lateral sinus, 5% sigmoid sinus and 65% had superior sagital and lateral sinus involvement simultaneously.Conclusion: In patients who refer having headache and papilla edema, cerebral vein thrombosis should be considered. Early diagnosis is achieved by precise diagnostic methods like MRI and MRV, and the prevention of severe irreversible and fatal side effects of disease with the early treatment.

Introduction: Granuloma Annulare (GA) is a granulomatous inflammatory lesion with unknown etiology. The etiologic relation between this disease and mycobacterium is still controversial. In this Descriptive-Cross sectional study, specimens of GA have been assessed for mycobacterium infection.Materials and Methods: Paraffin embedded specimens of GA from archive of Pathology department of Emam Reza hospital, during 2001 to 2005, have been selected Multiplex PCR were done on them, with primers of 162bp and 123bp for mycobacterium in general and tuberculosis respectively.Results: A total of 38 cases (31 female and 7 male) with the mean age of 42 years were found. The lesions were most commonly on upper extremities and the most common histological feature was lymphohistiocytic granulomatous inflammation of interstitial type (incomplete form of GA). With Zeil Nelson staining all cases were negative for acid fast bacilli. PCR In one case detected amplification of both 123 bp and 162 bp segments which were compatible with M. tuberculosis infection. This case had extensive lesions all over the upper extremities and back of the trunk and in histology it had a lot of giant cells which is not a usual finding in GA.Conclusion: Mycobacterium may cause some types of GA lesions.

Introduction: The prevalence of photo-aging and skin cancers has been increasing in many parts of the world. To reduce cutaneous photodamage and skin carcinogenesis, primary prevention that an integral component of it is the use of sunscreens is recommended. The aim of this study was assessment of SPF accuracy in some Iranian sunscreens.Materials and Methods: Among healthy individuals with skin types Ι to III, 25 volunteers enrolled, but finally ten persons for two sunscreens "X" and"Y" completed the study. Candidates were tested during three days using phototherapy UV 800 K with UV B lamps, UV skin-tester and UV-meter (Waldman Company, Germany). Minimal erythemal dose in unprotected areas of the skin (MEDup) was initially measured and then in protected areas (MEDp) was determined, according to the MEDup amount and national sunscreens´ SPF label (SPF=30).Volunteer was exposed to his own MEDp and also 85% of it, after 24 hours, the two areas were examined for erythema. The final test result declared "correct", for the tested cream, if the accuracy of the SPF was confirmed in at least 90% of volunteers. The accuracy of test was confirmed according to SPF assessment standard protocol.Results: All the candidates were male with mean age of 33.5±8.51 yrs. The MED mean was 73/09±15/6 mj/cm2. Final results declared "correct" for both products. In addition, the standard lotion test result was "correct" for all candidates.Conclusion: According to the results, we can assure people and physicians about reliability of labeled SPF, at least in some of the national products.

Introduction: The goal of this study was to compare the level of difference between cycloplegic and noncycloplegic refraction in different age groups.Materials and Methods: This correlation study was performed on 400 eyes of 200 participants in Khatam Al-Anbia hospital. For all participants, non cycloplegic refraction was done. Cycloplegia was performed, using Cyclopentolate 1%. Then cycloplegic refraction was done with the same autorefractometer. The amount of accommodation suppressed by the drug and possible effects of age, gender, type of refractive error and occupation on this amount was compared in different age groups. SPSS ver.13 statistical software was used for data analysis. P-value less than 0.05 considered as significant.Results: Average age of participants was 20.11±15.50 (range 2-59). The amount of accommodation suppressed by cyclopentolate 1% was significantly different among various age groups (p<0.001). The amount of accommodation suppressed by Cyclopentolate 1% showed no difference between myopic and hyperopic patients in any age groups (p>0.10 for each eye). Also, there was no correlation between occupation, sex and the amount of accommodation suppressed during cycloplegia (p=0.45 and p>0.10 respectively). Conclusion: Cycloplegic refraction is an effective procedure for patients under 50 years old. The type of refractive error, sex and occupation had no effect on the amount of accommodation suppressed by Cyclopentolate 1%.

Introduction: Combined modality treatments have been proposed for improving survival in patients with esophageal carcinoma. In this study, we evaluated the results of neoadjuvant radiotherapy and chemotherapy followed by surgery in patients with esophageal Squamous Cell Carcinoma (SCC).Materials and Methods: Between September 2001 and September 2006, 75 patients with Operable esophageal SCC underwent neoadjuvant radiotherapy (30 Gray/10 fractions in 34 or 40 Gray/20 fractions in 41 cases) followed by trans-hiatal esophagectomy at Omid Hospital, Mashhad, Iran. A total of 42 patients received at least 3 courses of chemotherapy containing cisplatin and 5FU.Results: Complete response to neoadjuvant treatment was found in 5 cases (6.7%). With a median follow up time of 13 months, 21 cases (28%) experienced recurrence including 9 locoregional recurrences, 9 distant metastasis and 3 concomitant local and distant failures. Period of 3-year survivals for all patients was 62.2%. There was no significant difference in survival between patients treated with either radiotherapy protocols (p=0.37). Patients who received at least 3 courses of chemotherapy had relatively better survival compared with those receiving less than three courses or no chemotherapy (p=0.09). In comparison with patients having grade III tumors, patients with grade I & II tumors had significantly better survival rate (p=0.05). Major treatment complications included leukopenia in 13 (17%), anemia in 6 (8%), Thrombocytopenia in 2 (3%), postsurgical fistula in 2 (3%) and anastomosis stricture in 8 (11%) patients.Conclusion: In this study, neoadjuvant chemoradiotherapy and surgery achieved satisfactory survival and acceptable incidence of complications for patients with esophageal SCC and we recommend further investigation in this regard.

The influenza Viruses, belong to the orthomyxoviridae and regarding to the epidemiology of worldwide respiratory diseases are inportant zoonoses.Avian Viruses have many subtypes, but four of them have high pathogenicity in human: H5N1, H7N3, H7N7 and H9N2. Avian Viruses may change their hosts. Adaptation of Virus with a new host has a complex process mostly unknown:1. adaptation to new cell surface receptor.2. changes in cell tropism.3. innate immunity.4. mechanisms of transmission.Influenza A (H1N1) Virus passed through these biological borders in 1918 and appeared as a new virus with high similarity to swine origin influenza Virus (S-OIV) and seasonal Virus. Influenza A (H9N2) Virus is a zoonosis and poultry is the main host of this Virus. The pathogenicity of H9N2 in human is low. But with increasing the recognition of seasonal influenza Virus receptors, it would be candidate of next pandemic.In treatment of pandemic influenza, (H1N1) oseltamivir and oral Neuroaminidase inhibitors usually are resisted. But Zanamavir is efective. Ribaverin is a nefective drug in A and B influenza Viruses, in seasonal influenza Ribaverin and Adamantane are sugestive.Aspirin as an antipyretic in these patients especially children, because of Reye synd is not recommended but other sedatives like acetaminophene are useful. Remaining at home, bed rest, washing hands and using mask is preventive and recommended.

Introduction: Extramedullary hematopoiesis is an important side effect of intermediate thalassemia. It is usually observed in paravertebral and other soft tissues as a compressive mass and rarely in intracranial, but it has not been roported in sphenoidal sinus in literature until now.Case report: In this article a 21- year old patient with intermediate thalassemia and sphenoidal mass has been reported. The patient underwent splenectomy and cholecystectomy simultaneously, for the billiary stones. After splenectomy his erythroblast increasesd progressively in peripheral blood, and one year later he was treated, because of acute sinusitis. Imaging studies and biopsy revealed the hematopoietic mass in sphenoidal sinus. The patient did not respond to surgical and medical treatments; therefore, he was referred for the hematopoietic stem cell transplantation. Conclusion: Ectopic hematopoiesis is a rare event in thalassemia, but it can appear in such important areas such as paravertebral and intracranial, which causes severe side effects. Therefore, immediate diagnosis and treatment in high risk patients can prevent these effects.