مجله دانشکده پزشکی اصفهان
پیاپی 129 (هفته اول اردیبهشت 1390)

Refractive eye are the most common people eye complaints and there are different ways to refractive correction. In this study we compare the effect of two phakic intraocular lenses, Artiflex versus Implantable Contact Lens (ICL).

In a prospective clinical trial study, 40 eyes of 20 patients who came to ophthalmology clinic to correct their refractive error were examined. In 20 eyes artiflex was inserted randomly and in the other 20 eyes, ICL was inserted. After 6 months uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), contrast sensitivity, intraocular pressure (IOP), specular microscopy and anterior uveitis was assessed in both groups.

In this study, there is no statistical difference between UCVA, BCVA, IOP, cataract incidence, contrast sensitivity, specular microscopy 6 months after surgery in both groups. 40% of eyes in Artiflex group developed anterior chamber reaction 6 months post-operatively but no patient in ICL group. So there is obvious difference in the rate of anterior chamber reaction between these two groups.

These two lenses have similar outcomes except in the incidence rate of anterior chamber reaction that is greater in the artiflex group. So these two lenses are safe with predictable outcome in treating high myopia.

Diabetes mellitus is the most prevalent endocrine disease and the most common cause of peripheral neuropathy which is one of the important late complications of diabetes. Careful neurologic examination and electrodiagnosis are essential and valuable in early diagnosis of neuropathy and prevention of its sequence. The aim of this study was to assessment the electroneurographic findings in diabetic patients. In this study 103 random selected diabetic patients who referred for electroneurographic studies were evaluated. Neurologic and electroneurographic examination were done in all patients. Three motor nerves (M-median, deep peroneal and tibial) and three sensory nerves (S-median, sural and superficial peroneal) were evaluated and in each nerve its conduction velocity, distal latency and amplitude and also bilateral H-reflex from soleus muscle were measured. Among 103 studied subjects, 30 patients (29.1%) had type I and 73 (70.9%) had type II diabetes mellitus. Overall incidence of diabetic neuropathy was 79.6%. There is direct correlation between duration of diabetes and prevalence of diabetic neuropathy. The most common complaint was numbness and tingling of distal part in 72% (P < 0.0001).The most common physical finding was abnormal ankle jerk in 94% (P < 0.001). The most sensitive finding in electroneurographic examination was absent or prolonged H-reflex in 92.5% (P < 0.0001). Overall, the parameter of amplitude was more sensitive than distal latency. Nerve conduction parameters especially H-reflex study and amplitude of sensory responses are valuable in early diagnosis of diabetic neuropathy. There is good correlation between clinical and electroneurographic findings, thus thorough clinical examination is highly recommended, to prevent unnecessary work ups and help preventing untoward complications.

Globally, stroke is the second leading cause of death. The aim of the present study was to determine the lipid profile in a group of Iranian patients with ischemic and hemorrhagic stroke. This study was performed in Alzahra University Hospital (Isfahan, Iran) in 2007. We included subjects with proved ischemic and hemorrhagic stroke. Blood samples were drawn within 24 h of admission for measurement of triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol. Data were analyzed by Student t-test and Mann-Whitney U test. Two hundred and fifty one patients were included (129 Men and 122 women). Mean age was 69.97 ± 10.63 years. There were 207 patients with ischemic stroke and 44 cases of hemorrhagic stroke. TG was higher in patients with ischemic stroke than in cases with hemorrhagic stroke (133.91 ± 67.84 mg/dl vs. 112.86 ± 40.92 mg/dl, P < 0.01). Patients with hemorrhagic stroke had higher levels of HDL than ones with ischemic stroke (55.43 ± 77.76 mg/dl vs. 39.78 ± 10.52 mg/dl, P < 0.01). LDL was higher in patients with hemorrhagic stroke than in cases with ischemic stroke (131.36 ± 45.98 mg/dl vs. 116.94 ± 40.02 mg/dl, P < 0.05). Mean TC did not differ significantly in two groups of patients. According to the present study patients with hemorrhagic stroke have higher HDL and LDL levels than ones with ischemic stroke. In contrast, TG is found to be higher in ischemic stroke cases than patients with hemorrhagic stroke.

We can prevent developing osteoporosis in rheumatoid arthritis (RA) patients with compounds containing calcium and vitamin D. In some of the studies, patients who received more vitamin D had better disease control. Our aim in this study was to observe whether the vitamin D could be effective on the rheumatoid arthritis disease activity or not? This study was a double blind randomized controlled clinical trial on 117 patients with rheumatoid arthritis. In Intervention group, in addition to drug therapy, vitamin D 50000 units per week were prescribed. Control group also received placebo tablets. In the end of study, results in both groups compared. Data analysis was performed by paired t-test, Student t-test and General linear Model. There were no significant differences in baseline disease severity, and DAS-28 in both groups. DAS-28 in intervention and control groups was 5.4 ± 1.1 and 5.5 ± 1.3, respectively (P > 0.05). In both groups, all clinical and laboratory parameters after intervention were reduced. The amount of reductions in intervention group was more than the placebo group but it is not significant. According to this research vitamin D can use as an adjuvant therapy for rheumatoid arthritis.

Rheumatoid arthritis is an inflammatory disease that involves small and middle size vessels, skin, and peripheral nervous system. Cerebral involvement in the setting of rheumatoid arthritis is rare but delay in treatment will lead to high morbidity and mortality. Case Report: A 65 year old man with a history of rheumatoid arthritis and chronic consumption of prednisolone 10mg/day since 10 years ago presented with drowsiness and decreased level of consciousness following a generalized pulsatile headache and was admitted in intensive care unit and neurology consult was requested. His initial examination revealed right sided hemiparesis and central facial palsy. In spite of starting antiplatelet and anticoagulant regimen, patient’s neurological signs were exacerbated and after 72 hours he developed quadriplegia, horizontal gaze palsy and disorientation. Considering his history of collagen vascular disease and no evident of cardiovascular risk factors, a methylprednisolone pulse therapy was started with suspect to a cerebral vasculitis. After the third dose, lateralized deficits were decreased and eye movement improved. After ninth day his consciousness reached to normal level. Probable diagnosis of cerebral vasculitis was confirmed by finding a characteristic change in vessels on brain CT angiography. It seems that central nervous system involvement is a rare finding in rheumatoid arteritis. But in the setting of a collagen-vascular disease, development of encephalopathy and rapid progression of focal neurological deficits, when other risk factors of atherosclerosis are absent, cerebral vasculitis should always be considered. Regarding to the high morbidity and mortality, it is important to start corticosteroid pulse therapy as soon as possible after other etiologies such as infection and vascular accidents were ruled out.