Medical Journal of Mashhad University of Medical Sciences
Year:2003 | Volume:45 | Issue:78|Papers Count:22

The etiology of Systemic Lupus Erythematosus (SLE) remains mystery. SLE is a multisystem disease, characterized by circulating auto antibodies and a variety of immunological abnormalities, which participate in the mediation of tissue damage. SLE is one of the rheumatological diseases that are associated with 85% hematological manifestation.We have studied major clinical and laboratory hematologic finding in 96 patients with SLE and comparison it with other countries.As the other results, M: F ratio was 1:7 and the mean diagnostic age was 21.3 years, the anemia was the most common hematologic manifestation, 79% of patients had anemia, most normochromic normocytic anemia. Leukopenia 32.3%, lymphopenia 68.8% and thrombocytopenia 15.2% were seen. 12% had coombs positive tests but we could not follow up patients for significant hemolysis. 12.5% of patients with SLE were VDRL positive, PT and APTT tests were abnormal in 5.8 and 12.1% respectively. ESR was elevated in 84.8%. The antinuclear antibodies (ANA) and antibody to double strand DNA (ds DNA) were positive in 98.8% and 83.6% respectively. LE cell was positive in 71.1% of patients with SLE.C3 and C4 were decreased in 82.1% of patients.

Cutaneous Lieshmaniasis or oriental sore, is one of the important diseases which has been C recognized in Iran since old times, and even today several significant concentrations occur in different parts of the country. City of Mashhad, located in the Northeast of Iran, is one of the endemic foci of the disease, more specifically occurring in the outlying parts of the city.This is a retrospective study, which has been carried out on 2226 patients referred to Ghaem parasitology Laboratory in two 5 years period. Between March 1979 to February 1983 and March 1997 to February 2001, (1600 in first period and 626 in the second period) using direct smear and Giemsa staining method for diagnosis.Totally 1478 (66.4%) patients had active sores, out of which 1106 patients (69.1 %) belongs to first period and 372 (59.4%) to second period of time respectively.Positive cases in first period of study were 636 males (69.6%) and 468 females (68.5%), while in second period of survey it was 173 males (59%) and 199 females (59.8%). In first period, face with 587(47.1 %) positive cases was the most prevalent part; while in second period hands with 301 (48%) cases were the most commonly infected parts.In both periods of study, children (6-10 year olds) comprised the most commonly infected group and the highest cases referred to laboratory were in autumn.So we conclude that, cutaneous leishmaniasis occurs throughout the year in Mashhad which means we have both rural and urban forms in the city. Secondly incidence of the disease decreases with age. Thirdly, improved knowledge and hygiene level of the people, methods to combat with calTiers and reservoir hosts caused 10% decrease of the disease in second period of study. Therefore it seems that, fears of general population about the disease is more than facts.

M. Tuberculosis infects one third of the world's population. Although considered primarily a pulmonary disease, tuberculosis can affect any organ system. One third of patients with tuberculosis wi11develop an extrapulmonary manifestation.The study of extrapulmonary tuberculosis (EPT) has been performed in low scale in our country and the relevant information is too low.This research is an analytic descriptive study, Which conducted to determine the epidemiological characteristics of extrapulmonary tuberculosis diagnosed in population of Mashhad during 5 years period from (1997-2001).During 5 years period, in Mashhad we retrospectively collected epidemiological data on all patients with newly diagnosed EPT. We found 1526 cases of EPT giving a mean annual incidence of 15.2 per 105 in that period.The results showed that 23 forms of EPT were diagnosed and tuberculous lymphadenitis was the most common form of EPT. The most common age of patients was 15-24 years (19.9%). The disease was more common in the female (63.3%). Foreign immigrants in Mashhad accounted for 397(26%) of 1526 cases of EPT diagnosed in Mashhad during 5 years period.In this study it was found that there is no significant changes in incidence of total cases of tuberculosis (Pulmonary and extrapulmonary) during 5 years period. The rate of EPT to total cases of tuberculosis was 33.53%.

patients with homozygous beta-thalassemia are chronically transfused and if not assiduously chelated, are at risk cardiac dysfunction. Available data suggest that even in optimally chelated patients, cardiac specimen is abnormal secondary to iron deposition, fibrosis, hypertrophy and the structural effects of chronic anemia. In poorly chelated patients, severe heart failure occurs and although it is easily predictable but invariably fatal.In order to evaluate cardiac performance 48 patients with beta-thalassemia underwent an M-mode and two-dimensional echocardiographic examination. They divided into 3 group: Group A: less than 100 times transfusions, group B: 100-400 times transfusions and group C: grater than 400 times transfusion. Echocardiography was used to study EF, FS, LPEPI LVET, RPEP/RVET, E/A after transfusion. Hemoglobin levels and serum ferritin checked before transfusion.No statistic correlation was found between echo cardiographic parameters and serum ferritin. In group A (15 patients) in 33% (five patients) RPEP/RVET was RVET abnormal. Over all 28/48 (58.3%) of patients? echocardiography findings was abnormal.In group A: (15 patients) in 33% (five patients) RPEP/RVET was abnormal but others parameters LPEP/LVET, EF, FS, E/A were normal.In group B: (25 patients) in 24% (6 patients) RPEP/RVET was abnormal and in 12% (3 patients) RPEP/RVET and EF were abnormal, but other findings LPEP/LVET, FS, E/A were normal.In group C: (8 patients) in 62.5% (5 patients) RPEP/RVET, 25% (2 patients) LPEP/LVET, 50% (4 patients) EF and 3 patients of 48 E/A was abnormal. In this group C only PS was normal.These findings suggest that RV dysfunction occur earlier than LV dysfunction in betathalassemia patients. We think that serial echocardiography of both left and right side of heart necessitates for evaluations of cardiac dysfunction in beta-thalassemic patients.

The coronary artery disease is one of the most common causes of mortality in the world Coronary angioplasty is a modern and effective mode of therapy in these patients and has recently been started in Mashhad. Its short-term results have not been evaluated before.In order to determine the success rate of angioplasty, its complications, the frequency of stent insertion and comparison of these data with other studies for the first time in Mashhad, this study was undertaken.During Feb.1999 to Feb.2001, 62 consecutive patients, and (73 coronary arteries) were selected in a prospective study in Mashhad University of Medical Sciences. Balloon angioplasty was performed for all of the patients. In cases of significant dissection (s) &Ior undesired results, stent insertion was undertaken immediately thereafter.Angioplasty was entirely successful in 69 arteries (94.52%), and four cases (6.45%) developed abrupt closure. None of the patients developed acute and/or sub acute thrombosis.Stents were utilized in 39 patients (53.42%). There was no statistically significant correlation between sex, left ventricular systolic function (LVSF) and complications of coronary angioplasty (P= 0.128 and 0.737 respectively).Despite some facilities and technical limitations, these data indicate that coronary angioplasty is a safe and effective modality for the treatment of coronary artery disease. The obtained data is comparable to other international studies in the literature. It has also been suggested that neither gender of the patients nor left ventricular systolic function had statistically important relationship to complication rates of coronary angioplasty.

Regarding incidence of pericardial effusion and its side effects, ethiology of this disease were studied in this research. Also cost of pericardiocentesis in diagnosing pericardial effusion, which is an invasive method, was evaluated.100 patients with pericardial effusion admitted in heart department of hospital were the subjects of our study. In information, including clinical finding, preclinical examination, echocardiography and perdicardiocentesis were gathered by means of a question form for each patient.Idiopathic, TB, Radiation, Cancer, uremia, trauma, post operation and hypothyroidism ordered by importance were found as primary reasons for incidence of pericardial effusion.According to our statistical tests, ethiology of pericardial effusion and pericardiocentesis, ethiology of pericardial effusion and sex, pericardiocentesis and sex are related consequently.Also, based on these results it seems that pericardiocentesis is a cost-effective diagnostic method.

Bacteria, amoebae and fungi usually cause keratitis. Mycotic Keratitis is the infection of cornea due to different types of fungi including molds and yeasts. Predisposing factors are Trauma (vegetable matter), surgery & prolong use of steroids. In order to investigate the prevalence of mycotic keratitis among the patients suffering from infection of corneaJa study was undertaken over a period of 6 years. We retrospectively reviewed the medical records of patients whom referred to Mycology lab from 1982 to 1995.After admission of each patient in mycology lab, a questioner including personal & clinical information was completed for him/her.Sampling by ophthalmologist & fresh smear and culture were performed for each patient. The results showed that %57 of the patients were male & the others were female Aspergilus spp & Fuzarium solani were isolated from 55% & 7% of the cultures respectively. Trauma due to penetration & plant particles was the common predisposing factor. The disease was a mostly seen in farmer.It is concluded that fungal keratitis should be considered in the differential diagnosis of keratitis specially if predisposing factor is trauma due to plant matter.

Inappropriate use of antibiotics is a common practice with hazardous results which emergence and spread of multiple drug resistant organisms is the most serious one. We studied antibiotic prescribing for hospitalized patients in medical and surgical wards of 17 Shahrivar Hospital of Mashhad for 8 months (June to January 1998-1999).During this period, 2401 patients of 3583 hospitalized patients received antibiotics, on the whole, antibiotics were used inappropriately in 97% (94% and 98% in medical and surgical wards respectively). The dosage or interval of antibiotic prescribing was inappropriate in 33% (55% and 17% in medical and surgical wards respectively). In 28%, duration of treatment or prophylaxis was longer .than is recommended (7% and 36% in medical and surgical wards respectively). Finally, in 29% antibiotics were prescribed without indication (19% and 36% in medical and surgical wards respectively). In our study, the most common fault in medical ward was wrong selection of antibiotics (66%) and in surgical ward was use of prophylactic antibiotics on wrong time (89%).In our study, inappropriate use of antibiotics was in unacceptably high and much higher than most other countries.

Impaired secretion of adrenal hormones can result from diseases of the adrenal cortex. or from insufficient secretion of ACTH or CRH from the pituitary or the hypothalamus. Both forms of diseases may be due to either hereditary or acquired causes. In infants and children the hereditary causes and enzymatic defects are the most common etiology of adrenal insufficiency.In this study the etiologies of adrenal insufficiency about 40 patients that admitted in pediatric ward of Imam Reza Hospital during 4 years were investigated. In our patients adrenal insufficiency was caused by enzymatic defects and hereditary disease in 82% and by acquired causes in 18%.The average ages of the patients were 15 months and both sexes were equally affected. Vomiting, failure to thrive, hyper pigmentation and poor feeding were the common signs. Although the adrenal insufficiency is relatively rare in children group but early diagnosis and appropriate treatment is important.  

Radioiodine therapy (RIT) is an effective, safe and easy method for treatment of hyperthyroidism. Multiple factors affect the success rate of radio- iodine therapy, however the success rate is increasing with time after RIT. This study tries to evaluate the success rate of high dose RIT (150-255 uci/gr) in different time intervals.During 3 years, 164 patients were treated with radioiodine. Questionnaires were filled for all patients including thyroid examination. Thyroid radioiodine uptakes were measured, and all patients were followed in 2-6months after radioiodine therapy and each 6 months thereafter up to 30 months. Thyroid volume measurement and clinical examination were performed for all patients in follow up visits.One hundred and thirty three females (81.1%) and 31 males (18.9%) were studied with a mean age or 44.6±14.3 yrs. Mean 1-131 doses per gram of thyroid weight was 186.6±22.5 uci/gr and mean total administered dose was 15.7±5.1 mci. Thyroid weight ranged from 20- 90 grams with a mean of 51.9 gr.Successful treatment were observed in 71.1 %, 78.7%, 83.7%, 91.4% and 95.5 in first to fifth follow ups, respectively. Hyperthyroidism also was seen in 35.5%, 42.6%, 49%, 54.3% and 72.7% respectively in the first to fifth follow-ups.Also Euthroid State was seen in 34.7%, 32%, 34.7%, 37.1% and] 8.2% of patient.Conclusion: With high dose radioiodine therapy (186.6 uci/gr), 71.7% of patients was successfully treated, 2-6 months later. Every 6 months success rates were increased 5.5% averagely to reach 95.5%, 2.5 years after therapy. In the first 2 years of follow up, 34.82% of patients were in Euthroid State and the rate was decreased thereafter.

This study was done on existing data of medical records of patients who had undergone PK because of keratoconus. The data used included age, sex, involved eye, VA, astigmatism, T spherical equivalent, mean keratome try, keratometric astigmatism, regularity and irregularity of cornea at different time intervals: preoperatively and postoperatively (first day, first week, first month, third month, sixth month, ninth month, next year and 2 year later).The records of 91 patients with keratoconus were reviewed. The common age group was 10-19 years, and the commonest of complaint of patients was decreased vision, so that 89% of patients had preop VA between hand motion to 3-m count finger. The results after two years were as follows: VA more than 6/10 in 61%, astigmatism less than 4D in 54%. Astigmatism axis of against the rule in 43% and mean keratometry in 71% patients was 40- 45. 99D. the spherical equivalent in 44% of patients was in the range of zero to -4D. According to the results of the study, penetrating keratoplasty is an excellent treatment for advanced keratoconus patients.

In all forms of osteogenesis imperfecta the tendency to multiple pathologic fractures and bone deformities as a sequella of these fractures are common. These deformities condemned with normal gait and physical activities of the patients. The bones in this disease are fragile, and multiple fractures and mal unions lead to constant morbidity. So aggressive management for these cases is very important.We are reporting 15 cases of osteogenesis imperfecta managed by multiple extraperiosteal wedge osteotomy and intramedullary fixation in an eight-year period (1994-2001). The pattern of inheritance was autosomal dominant in 11 cases, and mutation had been found in four cases.To assess the efficacy of this new method of osteotomy for prevention of complications, in 15 patients; 65 corrective osteotomies and 35 reoperations had been done. The operative technique in all of the cases was multiple extraperiosteal osteotomies, in which the segmented bone was not brought out of its periosteal coverage.In all operated cases clinical and radiologic union were achieved without any cases of nonunion and infection (early or late). Functional strength and ambulatory status of the patients had been improved after operation. Six from eighth wheelchair dependent patients were able to walk with crutches two patients could walk independently. In seven crutch dependent patients, all could walk independently.In contrast to the traditional osteotomies (So field and Millar) we did not have any case of infection or nonunion after our new technique of extraperiosteal osteotomy (%5 infection and %7 nonunion with So field & Millar). But there was no difference between the two techniques in point of view of the rate of reoperations for correction of the site of the nails or nail displacement.We recommend this new technique of osteotomy as a method of choice for correction of deformities in Lobestein's disease.

In some instances, differentiation between benign & malignant prostatic leisions with light microscopy even by an expert pathologist is not possible. So we try to evaluate distinction between nodular hyperplasia & adenocarcinoma by AgNOR staining.This study was performed on paraffin blocks from 58 case of Transe Urethral Resection Prostatectomy (TURP) and open prostatectomy, as below: Nodular Hyperplasia (n=27), Adenocarcinoma (n=31).Then AgNOR staining was done and the mean number, size & regularity of AgNORs dots in hundred-cel1 count were investigated.In the nodular hyperplasia, the mean number of AgNORs regions was 1,66/ per cells and in adenocarcinoma it was 2.38.In Prostatic hyperplasia these dots show small & regular in border, while in carcinoma they are larger, pleomorphic and have irregular borders.The "NORs" are the chromatin regions with weak stain property, which contain ribosome's genes & some argyrophilic proteins. The nucleolus appears around NORs in the late telophase; the number & size of them are related to proliferation & division process of cells.The AgNOR stain can be used for differentiation between prostatic carcinoma & nodular hyperplasia, but this method may not be as a reliable index for grading of prostatic adenocarcinoma.

A Nine-year-old girl with encephalopathy and history of 7 days fever cough and pharynigitis was admitted.Two days before admission she was brought to hospital and diagnosis was upper respiratory infection, and oral amoxicillin was prescribed. On the day of admission she developed a severe headache and emesis. There was not a history of skin-rash, diarrhea, and jaundice and there was no history of toxin-exposure, head-trauma and exposure to domestic animals and insect biting.On admission the temperature was 39 C, pulse rate of 120 beat/min, RR of 25/min and blood pressure 100/50. Pupils were reactive. There was no murmur, no jaundice, hepatosplenomegaly or skin rash.First lab examination were WBC, 12000/mm3 with 54% neut, 5% band forms, 25% lymph, 1% eosinophils and 15% atypical-lumphocytes. Platelets count 525000/ mm3, RBC 5500000/ mm3, Hb 11gr/dl. A lumbar puncture was done and CSF analysis revealed 40 WBC/ mm3, 88% lymphocytes. Protein 26 mg/dl and sugar 72 mg/dl.Arterial blood gases liver enzymes and serum electrolytes were normal. On chest x-ray opacity in the left lower lobe without adenopathy was seen. CT scan of head was normal.24 hours later, second lumbar puncture was done and CSF analysis performed. CSF and serology assays for mycoplasma pneumonia, Epstein-Barr virus, Herpex simplex virus, mumps, measles and Toxoplasma gondii performed. Blood smear for malaria and borrelia requested and cefotaxime and acyclovir were started. On third hospital day the patient was febrile, she however continued to the encephalopathic. On E.E.G. showed abnormal slowing waves.After receiving the results of lab, the diagnosis was established.

In November 2002, a businessman from the southern Chines province of Guangdong waS the first victim of a mysterious disease called Sever Acute Respiratory Syndrome (SARS).Guangdong province an agricultural area with a population of 75 million has a subtropical climates and rainfall of about 2m per. Year.Etiology of SARS in Europe strongly suggests that a novel Coronavirus is the causative agent. The virus isolation is by vera-cell cultures. In the serum of patient significant antibody can be found. Coronaviruses causes illness in many animals including pigs, cattle, dogs, cats and chickens. Coronavirus are associated with upper respiratory infections. Genetic changes occur frequently and the proximity of humans to animals in China may have caused a recombination animal-virus to become aM accidental tourist. Crossing species to human in China, causing an epidemic among highly mobile and susceptible population.Genetic characteristics of isolated virus in SARS patients indicate that 50-60 percent of Nucleotide sequences of virus is distantly related to known Corona virus.SARS is a condition associated with substantial morbidity and mortality. It appears to be of a viral origin, with patterns suggesting droplet of contact transmission. The role of human Metapneumovirus and novel Coronavirus, or both requires further investigation. SARS is a condition with unknown cause! That has recently been recognized in Asia, Europe, and North America. As defined by WHO a suspected case is disease in a person with fever (>3°C), lower respiratory tract symptoms and contact with a person believed to have had SARS or a history of travel to a geographic area with known SARS epidemic.

pleuropulmonary blastoma is a rare and aggressive malignant neoplasm that typically occurs in young children. It is distinct from ordinary pulmonary blastoma or carcinosarcoma of the lung. Primitive blastoma and malignant mesnechymal stoma that often demonstrates multidirectional differeI1tiation and has no malignant epithelial component histological1y characterize this neoplasm. It has been classified as type I, II or III on the basis of the cystic versus solid nature of the lesion as well as the histologic appearance.We report a case of pleuropulmonary blastoma arising in a four -year-old girl and involving the middle iobe of the right lung. In this article we emphasize on histopathological hallmarks of pleuropulmonary blastoma that must be considered in guide to the correct diagnosis and optimal treatment.

Megalourethra is a rare entity that is associated with abnormal development of the corpus spongiosum or corpora covernosa.Traditionally megalourethra has been divided into two varieties: scaphoid and fusiform. Because of rarity, we report scaphoid megalourethra in the 13 years old male that presented for circumcision. Sonography of kidneys was normal and in retrograde urethrography severe bulging was seen in anterior urethra. The patient underwent urethral reconstruction by circumcisional incision and had urinary diversion for 7 days.

Pulmonary artery aneurysm is one of the complications of pulmonic valve stenosis that may be misdiagnosed as mediastinal or lung mass at specific situation. In this article one rare case of pulmonary artery Aneurysm in 40 years man is present. This man admitted to clinic due to dry cough: hoarseness and exertional dyspnea. Further evaluation with CXR: echocardiography, CT. Scan and catheterism confirmed large main PA and left pulmonary artery aneurysm due to valvular PS.After confirmation of diagnosis by angiography Pt referred to cardiac surgeon and successful surgery was performed.

Serum and CSF collected on second hospital day were analyzed and IgM-Elisa assay for M.pneumonia was positive but IgG-Elisa assay was negative. Cold agglutinin was strongly positive too (titer; 1: 1200).Serologic tests for EEV; HSV, Measles, Mumps, Toxoplasma and rubella were negative. CSF and blood cultures were negative, because of serum and CSF IgM Elisa positive reports, acyc10vir and cefotaxime discontinued and Erythromycin and Dexamethasone started. A brain CT scan was done without abnormality. Convalescent sera after discharging patient were analyzed and it was strongly pO$itive for IgG-Elisa assay for mycoplasma pneumoma.The patient was two weeks on orally erythromycin and one week on dexamethazone and she discharged after 20 days hospitalization.Neurologic complications as an extra-pulmonary complication of M. pneumonia infection usually occur 10 days after respiratory syndrome with a range of 3-23 days. The age range of patients with CNS syndromes is 0.8 to 14.6 years.The diagnosis of CNS syndrome in mycoplasma infection associated with meningitis or having evidence of mycoplasma infection associated with neurologic syndromes makes encephalitis. IgM-Elisa assay is a sensitive and specific test. A rising IgG-Elisa test in convalescent sera (4 fold or more) suggest infection. E.E.G. abnormalities in CNS mycoplasma infection are a common finding. Mycoplasma infection with CNS involvement is believed to have autoimmune pathogenesis and interval between respiratory illness and CNS syndrome confirms this suggestion.