مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و سوم شماره 1 (پیاپی 107، بهار 1389)

There are some reports about the association of autoimmune thyroid diseases with human T cell leukemia virus type I (HTLV-I) infection. The objective of this study was to estimate the seroprevalence rates of anti-thyroid antibodies in HTLV-I carriers and HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients in Mashhad, north east of Iran, to determine any association between HTLV-I infection and Hashimoto’s thyroiditis (HT). A total of 46 HTLV-I infected patients (24 patients with HAM/TSP and 22 asymptomatic carriers) and 40 HTLV-I seronegative healthy individuals were screened for the presence of thyroid autoantibodies. The diagnosis of HT was based on the presence of positive thyroid autoantibodies (Anti thyroid peroxidase and/or Anti thyroglobulin) and at least one of two additional criteria (hypothyroidism and/or goiter). Analysis of data was done, using Fisher-Exact test by statistical software SPSS version 13.0. A P value below 0.05 was considered statistically significant. Positivity for thyroid autoantibodies was found in 14 (63.6%) of 22 asymptomatic carriers, 6 (25%) of 24 patients with HAM/TSP and 3 (7.5%) of 40 HTLV-I seronegative healthy individuals. HT found in 45.4% of asymptomatic carriers, 25% of HAM/TSP patients and 5% of seronegative healthy individuals. This study demonstrates a high prevalence of HT in the HAM/TSP patients and the HTLV-I carriers in Mashhad. Our findings suggest an association between HTLV-I infection and HT in our region.

Atherosclerosis and its related diseases are major causes of mortality in many countries. Our knowledge of its background is of much importance. In recent years, researches have been preformed on relation between atherosclerosis and IGF-I plasma levels and different results obtained. We decided to do this research, as few studies have been done in this field in our country. Altogether One hundred and seven patients who were candidates for the coronary angiography were chosen for study. Blood samples were taken for measuring IGF-I, FBS, triglyceride, total cholesterol, LDL and HDL in plasma. Blood pressures of patients were recorded, and their BMIs accounted. It was also written in questionnaire if they had history of cigarette smoking. IGF-I plasma levels increased in relation to intensity of coronary artery stenosis; correlation coefficient between stenoses and IGF-I plasma levels was as follows: R= 0.204 p= 0.04. This suggested significant and meaningful relation between these variables. IGF-I plasma levels also showed mild increase in relation to number of diseased coronary arteries. By using the analysis of spierman correlation coefficient, Rho= 0.189 and p= 0.058 were accounted. We concluded that IGF-I plasma levels were in direct and meaningful relation to stenosis values of coronary arteries, and in mild relation to number of diseased coronary arteries. These findings can explain the role of IGF-1 in process of atherosclerosis.

Mycotic Keratitis is a suppurative, usually ulcerative, and sight threatening infection of cornea that sometimes leads to loss of vision. The peak of incidence is observed in the tropical and subtropical regions. To investigate the etiological agent, predisposing factors and treatment follow up of mycotic keratitis; this study was undertaken over a period of 2 years in Mashhad. In this prospective, cross sectional study, among 466 individuals suffering from keratitis,65 patients, highly suspected to mycotic keratitis were examined by direct fresh smear (KOH 10%) and culture in Mycology Media. The results were analyzed by SPSS method. Among 65 clinically suspected individuals, the results of direct smear and culture of 44 patients were positive. of patients, 21 were male (47.1%) and 24 were female (52.3%). The patients were between 8 to 84 years old. More than 40% of them were farmers. Trauma was the most common predisposing factor in more than 47% of cases due to vegetable materials. Molds and Yeasts were isolated from 86.4% and 13.6% of the samples respectively. Fusarium spp. were the most frequent isolates (44.4%).Others included Aspergillus spp. (21.8%), Acremonium spp. (8.3%), Penicillium spp. (5.6%) and Candida albicans (13.9%). Tearing and redness were the most common symptoms observed (93.2%). Amphotricin B was used in patients with Aspergillus and Candida Keratitis, but for Fusarium and other molds keratitis, Natamycin was used for 6 to 12 weeks. In one patient with Fusarium Keratitis, medical therapy was failed and therapeutic penetrating keratoplasty was performed. Six months follow up showed that prognosis was good in all of the patients. In relation to the last decade, the incidence of Mycotic Keratitis is increased in Mashhad. Keratitis due to the molds is more prevalent than yeast keratitis. Entrance of foreign body (Plant particles) is the most common predisposing factor. However, it needs long term therapy but the prognosis is good.

Ocular emergency is one of the most common problems in the Emergency Department (ED), but a general survey of ocular emergencies has rarely been reported in the literature. This study reviews cases of ocular emergencies presented to the ED of Khatam Hospital (Mashhad) over a 6-months period. A retrospective analysis was done on patients who presented with eye complaints to the ED of Khatam Hospital-Mashhad between March 2007 and August 2007. Ocular diagnoses and hospitalizations due to ocular emergencies in addition to their associated variables were collected and assessed separately. 28,312 patients presented to the ED during the period with eye complaints. The most frequent diagnoses in newly presented patients were grouped as trauma (61%) and inflammatory disorders (22%). A male to female ratio of about 2.5:1 was assessed. Both genders had the peak age in the third decade. There was a trend toward increased numbers in late spring and early summer. There were a total of 431 cases of hospitalization (1.5% of all presented patients) most of them due to traumatic consequences notably globe rupture (38% of all hospitalizations). Ocular occupational casualties estimated to be responsible for 43% of all traumatic injuries occurred between 20-59 years of age. Young males were found to run a higher risk of ocular accidents, especially at work. Individuals under 10 years of age estimated to be particularly at risk for severe ocular traumas e.g. eye penetration. Taking more care of these two specially at risk groups and directing protectional educations and preprations towards their work and play could be suggested.

In recent years, we have noticed that centres for clinical treatments have facilitates for surgery patients. These facilitates can help patients and theirs families to take recovery and safety in using healthy professional cares. Telephone follow-up following office in out-patients is usual observation for their surgery. The aim was evaluation of security and safety of this method of follow-up and use of this method for the post operation pediatric patients who visit the clinic. The patients followed up for 6 months after the surgery by telephone. Special form completed for each patient. These forms were clinical records and follow-up. We evaluated 120 out-patients. In 108 cases, we had good communications with their parents. Twelve cases didn’t have an communication (neither telephone nor through post operation visit to clinic). A total of 10 cases came to clinic for the post operation visit without any calling them, because they thought that they were needed. Although, we advised 8 cases to visit the clinic. Follow-up through telephone with organized protocol is a current method of follow-up in elective surgical patients. It is not only safe but also it is less expensive and saves time for patients, parents and physicians.

Upper gastrointestinal (UGI) endoscopy is the most reliable modality for evaluating patients with caustic injury of GI tract; however there is an ongoing debate on its optimal timing. 100 adult patients with definite diagnosis of injury due to corrosive ingestion on direct laryngoscopy were evaluated in Tabriz Emam Khomeini Hospital during a 15-month period. The patients with signs and symptoms indicating a serious internal injury were operated immediately. In other patients, endoscopy was employed and according to timing, patients categorized in two groups; early (<24 h) and late endoscopy (>24 h). Inhospital condition of the two groups was compared. 62 females and 38 males (25.51±9.25 y/o) were recruited. Alkaline materials were used in majority of cases (83%). Eight percent of the patients were operated immediately. Early endoscopy was employed in 37% of patients and 55% underwent late endoscopy. Endoscopy results were normal in 11%, grade I in 36%, grade II in 22%, grade III in 11% and grade IV lesion in 12% of the patients. There was no significant difference between the two groups regarding the need of operation, gap between admission and operation, need of ICU admit and its duration and inhospital morbidity and mortality. However, operation gap and ICU admit were apparently better in early endoscopy group and morbidity was lower in late endoscopy group. Early and late endoscopy did not significantly affect inhospital condition of adult patients with corrosive ingestion. However, early endoscopy was apparently along with better results.

Considering its typical clinical manifestation, Dermatofibroma (DF) can be clinically diagnosed in most cases. It has been nevertheless, common practice to rely on pathologic diagnoses. We decided to estimate the rate of correct clinical diagnosis and also the relative importance of other lesions in differential diagnosis of DF.

We studied archived biopsies in Dermatology and Pathology Department of Emam Reza hospitals from 1984 untill 2004 and Dermatofibroma cases were selected, then slides were reviewed. Demographic and other relevant data such as age, sex, etc were gathered and analysed.

Eighty two of 127 clinically diagnosed dermatofibroma cases were confirmed by histologic examination (positive predictive value 64.5%). The most common histological diagnosis in the remaining 45 cases were nodular hidradenoma (7 cases) and comedon and epidermal cyst (11 cases collectively). In addition, 32 cases of histologically diagnosed dermatofibroma were found with different clinical diagnosis. According to our data, the sensitivity of clinical diagnosis was 72%. It was also found that the lesion is more common in females (57%) and in extremities (58%). It often appears as a nodular (72%) lesion measuring 5 to 15 millimeters.

Histopathologic examination is important for diagnosis of Dermatofibroma. According to our data, the probabilities of false positive and false negatives were 35.5% and 28%, respectively, which is equivalent to 64.5% positive predictive value (PPV).

Pilonidal sinuses typically occur in the midline of the sacrococcygeal skin of young men that is treatment is surgical management. Since its wound healing typically requires long time and information about benefits of zinc compounds in wound healing, we asked to evaluate of the effect of topical zinc oxide ointment on healing of the acute open wounds due to surgery of pilonidal sinus. In double blind, randomized, placebo control study sixteen men were not been diabetic, renal failure or cirrhotic and not used corticosteroids, after surgery with complete simple excision approach, evaluated in two groups that have been dressed daily with topical zinc oxide ointment (case group) and placebo (control group). Every 15 days average of percentage of wound healing has been compared in two groups by measuring of volume of wounds. Mean of age in patients was 24.5±4, has no significant difference in groups (p= 0.634). Means of percentage of volume changes in first and second 15 days have no significant difference in groups (p= 0.334), (p= 0.175). But means of percentage of volume changes in third 15 days and in total 45 days duration of treatment have significant difference (p= 0.006), (p= 0.026). In attention to this study and other searches, dressing with zinc oxide ointment is benefit in increase of healing rate of chronic and acute wounds. The effect of drug is significant in third 15 days that is properly because of principle effect of zinc in epithelialization phase.