Caspian Journal of Internal Medicine
Volume:1 Issue: 3, summer 2010

A number of patients with inflammatory arthritis due to inadequate clinical or laboratory data do not fulfill diagnostic criteria for a clinical disease categories. These patients with initial diagnosis of undifferentiated arthritis (UA) may remit or progress to a definite well- defined condition such as rheumatoid arthritis (RA) or remain as UA with persistence of inflammatory arthritis. The main objective in the evaluation of these patients is focused on differentiating self-limiting arthritis from those who progress to chronic destructive arthritis such as RA. The study reviews the background data regarding the associated factors of progressive diseases among patients with recent-onset arthritis as well as the evaluation and decision in the management of this population. At present، the major goal should be focused on the early identification of patients، who have progressive course and initiation of appropriate therapy by using Disease Modifying Anti Rheumatic Drugs، (DMARDs) as early as possible to achieve clinical remission.

Halothane is the routine used inhalation anesthetic drug in the world but at present, there is an increasing interest for using intravenous anesthetics like propofol. The purpose of this study was to compare these anesthetic effects on hepatic enzymes. From 2006 to 2007, this study was performed on fifty eight patients classified in class I of American Society of Anesthetics. These patients had no preliminary symptomatic hepatic, cardiac or renal disease admitted for elective surgery in Yahyahnejiad Hospital, Babol University of Medical Sciences. These patients were divided randomly into two groups. Thirty patients in the study group (Propofol) and twenty eight patients in the control group (Halothane). In both groups, pre-meditation and induction of anesthesia were the same. For the maintenance of anesthesia in the study group there was continuous infusion of propofol and for the control group, 0.5-1% halothane inhalation. From all the patients, we got three blood samples separately prior to the anesthesia, twenty four hours and seven days after the anesthesia. These samples were tested for aspartate aminotransferase (AST), alanine amino transferase (ALT), alkaline phosphates (ALP) and Billirubin (total and direct). Seven days after anesthesia ALP, the total and direct Billirubin levels did not have differences between the two groups. However, AST (p=0.008) and ALT (p=0.003) increased in halothane group in compared with propofol group. The results show that propofol has less effect on liver enzymes as compared to halothane.

Helicobacter Pylori (H.P) and Non Steroidal Anti inflammatory Drugs (NSAID) are the most common cause of peptic ulcer Disease (PUD). This study was designed to identify endoscopic, clinical and demographic features of patients with H.P positive in comparison with NSAID related PUD. From December 2004 to March 2008, 5885 patients underwent upper GI Tract endoscopy in a large referral Teaching Hospital of Babol Medical University. All patients with endoscopic diagnosis of PUD were enrolled in the study. H.P positive patients were assigned as group A and NSAID user as group B. Then their clinical, demographic, endoscopic characteristics were compared. A total of 749 (12.3%) patients diagnosed as Duodenal Ulcer (DU), among them 600 subjects were eligible for analysis. Three hundred thirty one (55.2%) were H.P positive, 80 (13.3%) were NSAID user and 189 (31.5%) had non H.P non NSAID related ulcer. Two hundred ninety seven patients diagnosed having Gastric Ulcer (G.U), 143 (48.2%) were H.P positive, 46 (15.5%) were NSAID user and 108 (36.3%) had non H.Pylori, non NSAID related ulcer. Mean age of patients with G.U was 54.2±17 and D.U was 46.9±17.5 years (p<0.04). Anterior wall of bulb and antrum were the most common site of patients with D.U and G.U respectively. This study shows non H.Pylori non NSAID related ulcers comprise a significant portion of peptic ulcer disease in north of Iran.

Peak Expiratory Flow Rate (PEFR) is recommended as a tool for control of asthma. The purpose of this study was to determine the normal value of PEFR in the healthy high school children in Babol, Iran. This study was conducted on 470 healthy high school children (285 girls, 185 boys with the age between 14-18 years). For the determination of PEFR we used Mini Wright Peak Flow Meter. At a three time measurement, the highest value of PEFR is recorded. Formula for prediction of PEFR was estimated by linear regression analysis after the correlation of PEFR with the age, height and weight. The mean PEFR in the boys was 546.57±74.92 and in the girls was 424.48±52.29L/m. The amount of PEFR was increased regarding age, height and weight. The formula for prediction of PEFR was estimated: For boys: weight ×1.59+height×2.24+age×1.47-135,For girls: weight ×0.86+height×1.46+143.17 The results show that the normal range of PEF is different from that reported to the other countries.

Pithyriasis Alba (PA) is a nonspecific dermatitis with unknown origin and is a common dermatosis during childhood. Its prevalence is higher in individuals with darker skin, inadequate personal hygiene, sun exposure, xerosis with atopic dermatitis. The purpose of this study was to determine the prevalence of pithyriasis alba in elementary school children in Babol, Northern Iran. This cross sectional study was carried out on 937 children in elementary schools in Babol, north of Iran, from 2007 through 2008. The diagnosis of the disease was made through clinical examination. The variables like age, gender, areas of skin lesions were also evaluated. Data were collected and analyzed. Nine hundred-thirty seven children (491 boys and 446 girls) between the ages 7-11 years were examined. P.A was seen in 44 (9.9%) out of 446 girls and in 44 (9%) out of 491 boys (p>0.05). The prevalence of PA was 9.4%. The results show that the prevalence of pithyriasis alba was relatively high in the school children. Preventive protocols for the infected children are recommended.

Behcet syndrome is a recurrent inflammatory disorder that frequently involves the ocular system. The purpose of this study was to determine the frequency of ocular involvement in cases of Behcet''s disease in Babol, north of Iran. From April 2003 to December 2009, 100 cases of behcet''s disease who were admitted at the Department of Ophthalmology and Internal Medicine of Babol University of Medical Sciences, in Babol, were studied. The diagnosis of the disease was performed by the Iranian criteria for the diagnosis of the behcet''s disease. The demographic data, clinical manifestations as well as the frequency of ocular involvement were recorded and analyzed. Sixty-one (61%) were male and 31 (31%) were female. The mean age of the male patients was 28.2 and the female patients were 27.5 years. The most common clinical findings were oral aphtose (90%) followed with ocular and genital involvement. In ten cases ocular involvement was the sole initial clinical symptom. Among the 70 cases with ocular involvement, bilateral involvement was seen in 78.6% and unilateral involvement in 21.4% cases. HLA- B5 was positive in fifty two (74.2%) cases with ocular involvement, whereas 18 (25.7%) with ocular involvement had negative HLA- B5. The results show that the frequency of ocular involvement in patients with behcet''s disease is relatively high. Investigation of eye involvement in subjects with recurrent oral or genital ulcers is recommended.

The outcome of Hepatitis B virus (HBV) infection is chronic or resolved HBV infection. Over the time, the levels of HBsAg or Anti-HBs declined and were not detectable in their sera and was named as isolated anti-HBc. The purpose of this study was to assess the prevalence of isolated anti-HBc in previously HBV infected individuals. From April 2000 to September 2008, the results of HBV markers on 2036 cases of previously infected individuals were recorded. Those who were HBsAg or anti-HBs negative but anti-HBc and anti-HBe positive was named as isolated anti-HBc. The prevalence of isolated anti HBc in both males and females was determined. Among the 1160 males with past HBV infection, isolated anti-HBc was seen in 35 (3%) cases. The mean age of these cases was 33.8±13 years. Isolated anti-HBc was seen in 44 (5%) cases of 876 females with previous HBV infection (p=0.014). The prevalence of isolated anti-HBc was 79 (3.9%). The result of this study emphasizes on the differentiation of occult or resolved HBV infection in isolated anti-HBc cases in endemic regions of HBV.

Interferons (IFNs) are common therapeutics for several diseases such as viral hepatitis, multiple sclerosis and malignancy. A variety of autoimmune related side effects have been observed during IFN therapy. Rare cases of myopathy, polymyositis or dermatomyositis have been reported during therapy with high doses of IFNα. In this report, we describe a case with severe muscle weakness but near normal muscles′ enzymes during treatment of chronic hepatic C infection with pegylated IFN α 2a in a patient with major beta thalassemia This report suggests that severe weakness with normal muscles′ enzymes may occur during IFN therapy.

Familial chylomicronemia syndrome is a rare disorder of lipoprotein metabolism due to familial lipoprotein lipase or apolipoprotein C-II deficiency or the presence of inhibitors to lipoprotein lipase. It manifests as eruptive xanthomas, acute pancreatitis, and lipaemic plasma due to marked elevation of triglyceride and chylomicrons levels. We report a rare case of familial chylomicronemia in a 5 year old girl who was diagnosed after her plasma was incidentally found to be milky. Lipid profile showed familial chylomicronemia. The girl was advised on a low fat diet and a regular follow up check up. Pediatricians should be alerted for the possibility of familial hyperchylomicronemia due to apolipoprotein CII deficiency and initiate appropriate treatment.