Caspian Journal of Internal Medicine
Volume:2 Issue: 1, Winter 2011

Rheumatoid arthritis (RA) is an inflammatory progressive disease which in the absence of appropriate treatment can lead to joint destruction and disability. Prognosis of RA may be predicted based on the presence of some clinical and laboratory evidences.New criteria for classification of RA provides opportunity for earlier treatment. Initiation of treatment particularly by combination of DMARDs concurrent with short duration of corticosteroid is expected to prevent progressive course and even change the natural course of RA.At present any patients with clinical synovitis in at least one joint may have definite RA, requiring agressive treatment.

Thyroid cancer is the most common endocrine malignancy. Several risk factors were found to play a role in thyroid cancer. The purpose of the study was to determine the risk factors for thyroid cancer, in Babol, north of Iran. 80 patients with thyroid cancer were selected as case group and 160 people living in the neighborhood of the patients as control group. Risk factors in both groups were collected and compared. The odds ratio (OR) as well as the marginal logistic regression model were used to estimate the possible risk factors. X-ray exposure, radioactive exposure, family history of thyroid cancer, history of hyperthyroidism, hypothyroidism and thyroid resection were found to be the risk factors of thyroid cancer (p<0.05). Passion exposure, OCP user, history of hysterectomy, history of thyroid nodule were not correlated to thyroid cancer (p>0.05). History of goiter or other benign thyroid diseases are among the thyroid cancer risk factors in some community-based interventions to prevent or treat the disease in early stages are recommended in our region.

An imbalance of the cerebrovascular response during functional activation of the brain has been postulated as a factor in the pathophysiology of migraine. The purpose of this study was to determine the transcranial doppler sonography (TDS) diagnostic value for the cerebral flow velocity changes in the interictal phase of classic migraine. This study was carried out on 46 patients (23 cases and 23 controls). We used Doppler instrument via trans-temporal window and detected middle cerebral artery, anterior cerebral artery and posterior cerebral artery by 2 MHz probe. The flow velocity in the posterior cerebral artery before, during and immediately after stimulation was recorded. Stimulation was done using a flickering light in 100 seconds. At the baseline, the middle cerebral artery had more peak systolic velocity in migraineurs than the control group. Although peak systolic velocity changes in the mid-photic period is not statistically significant. On the other hand, post-photic peak systolic velocity increased significantly. The diagnostic accuracy of the peak systolic volume (PSV) changes in the posterior cerebral artery (PCA) for the migraine was 72.3%. This stimulation we found altered cerebral vasomotor reactivity in the interictal phase in migraineurs with visual aura. This seemed to be an unavoidable hindrance for the wider implementation of functional TCD in diagnostic work up of migraine patients.

Quality of life (QOL) assessment in patients on chronic Hemodialysis (HD) or peritoneal dialysis (PD) has rarely been carried out. The aim of this study was to assess the quality of life during hemodialysis and peritoneal dialysis treatment in patients referred to teaching hospitals in Urmia, Iran. All chronic HD and PD patients in Taleghani and Imam Khomeini Teaching Hospitals in Urmia were requested to fill in the validated with a health-related quality-of-life SF36 questionnaire for assessing health status in five dimensions and on a visual analogue scale, allowing computation of a predicted QOL value to be compared. Of the 558 questionnaires distributed to chronic HD patients, 455 were returned (response rate 82%). Fifty out of 64 PD patients (78%) returned the questionnaires. The two groups were similar in age, gender and duration of dialysis treatment. Mean QOL was rated at 60±18 for HD and 61±19 for PD, for a mean predicted QOL value of 62±30 and 58±32, respectively. Results of the five dimensions were similar in both groups, except for a greater restriction in usual activities for PD patients (p= 0.007). The highest scores were recorded for self-care, with 71% HD and 74% PD patients reporting no limitation, and the lowest scores for usual activities, with 14% HD and 23% PD patients reporting severe limitation. Experiencing pain/discomfort (for HD and PD) or anxiety/depression (for PD) had the highest impact on QOL. The results show that QOL on PD was better, but such studies have not been performed in various areas in Iran and the results may be different because of the involvement of many factors such as geographical, socioeconomic and cultural items. More studies are required to verify the value of the SF36 measurements in predicting the clinical condition of patients with ESRD and their outcomes.

One of the most common endocrine problems in major beta-thalassemia is hypothyroidism (HT). The aim of this study was to evaluate thyroid function status in major β-thalassemia patients older than 10 years old. This cross sectional study was carried out on thalassemia major patients registered on Thalassemia Center of Amirkola Children Hospital in Babol. A questionnaire was filled out by the patients to evaluate the demographic information, quality of their last transfusions and chelation therapy. Growth parameters were evaluated. We assessed serum T4, TSH, T3RU and FTI in all patients and those with hypothyroidism, anti-thyroglobulin and anti-thyroid proxidase antibodies were checked. One hundred-thirty patients (56 males and 74 females) were enrolled in this study. The mean age was 20.95±7.8 years. Short stature was seen in 41(31.3%) patients. In 53(40.8%) patients, weight was under normal range. HT was found in 19 patients (14.6%); 2 primary overt HT, 3 secondary HT and 14 subclinical HT were detected. No patient with HT had significant serum level of anti-thyroid antibodies. Correlation between HT and serum ferritin level was not significant (p=0.584) but it was significant for HT and short statures (p=0.002), also regular transfusion and chelation therapy were correlated with ferritin level. High prevalence of HT among thalassemic patients signifies the importance of regular screening for evaluation of endocrine function in these patients; especially when short stature is present.

High maternal hemoglobin (Hb) concentration was considered a risk factor for the developing of pregnancy hypertension. The purpose of this study was to determine whether high maternal Hb concentration in first trimesters associated with pregnancy induced hypertension in Iranian nulliparous women. This study was carried out in teaching hospital in Sari, Iran. Samples were obtained from 1008 women who were almost on their 14th week pregnancy and were admitted to prenatal clinic of this hospital from October 2008 to December 2009. Their blood pressure was normal. After measuring Hb at first visit, they were divided into groups (11≤Hb<13.2 and Hb≥13.2). Pregnancy induced hypertension in these groups were compared. In normal Hb group, 14(2.75%) women had hypertension and in high Hb group, 21(4.2%) had hypertension (p=0.045). High hemoglobin concentration in the first trimester showed a risk factor for pregnancy induced hypertension (OR= 2.462; 95% CI, 1-6.9). The results showed that women with high hemoglobin concentration in the first trimester carried an increased risk of pregnancy induced hypertension.

Mycobacterium marinum infection has a worldwide distribution and the organism occupies many aquatic environments. Infections in human consist of nodular cutaneous lesions that can progress to tenosynovitis, arthritis, and osteomyelitis. A 27-year-old man was presented with a history of swelling and exudative erythematous lesions and pustules of the right forearm. He worked as a laborer at an aquarium store. A smear from the walls of the necrotic center when stained for acid-fast bacilli revealed organisms consistent with mycobacteria. Cutaneous nodular lesion on the hand or forearm of the patient working in aquatic environment, M marinum should be considered in the differential diagnosis.

Nowadays, drug and observation are advised to patients with lymphocytic hypophysitis and in some cases with nonfunctioning pituitary macoadenoma, instead of surgery. In this article, we report a woman with nonfunctional pituitary macroadenoma and panhypopitutarism and negative criteria for lymphocytic hypophysitis associated with increased liver enzymes. After three months adenoma rapidly regressed and liver function tests were normal without any treatment. Seemingly, viral infection as one of the factors may be considered in cases with spontaneous regressed pituitary nonfunctional adenoma.